Healthcare Provider Details

I. General information

NPI: 1679661086
Provider Name (Legal Business Name): PATTY MELISA HORTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N JEFFERSON ST
MACON MS
39341-0480
US

IV. Provider business mailing address

PO BOX 480
MACON MS
39341-0480
US

V. Phone/Fax

Practice location:
  • Phone: 662-726-4620
  • Fax: 662-726-4204
Mailing address:
  • Phone: 662-726-4620
  • Fax: 662-726-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR855604
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: