Healthcare Provider Details

I. General information

NPI: 1497643779
Provider Name (Legal Business Name): KEVIN DOUGLAS HORN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W 21ST ST
CLOVIS NM
88101-4149
US

IV. Provider business mailing address

2006 53RD ST
LUBBOCK TX
79412-2714
US

V. Phone/Fax

Practice location:
  • Phone: 575-904-7577
  • Fax: 505-369-3406
Mailing address:
  • Phone: 817-219-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85746
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN324390
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: