Healthcare Provider Details

I. General information

NPI: 1376363044
Provider Name (Legal Business Name): TANYA NICOLE HORTON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST STE A
MONTICELLO MS
39654-3702
US

IV. Provider business mailing address

86 HOOKER RD
SILVER CREEK MS
39663-4320
US

V. Phone/Fax

Practice location:
  • Phone: 769-600-2221
  • Fax: 601-653-9645
Mailing address:
  • Phone: 601-596-7301
  • Fax: 601-653-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: