Healthcare Provider Details

I. General information

NPI: 1689911869
Provider Name (Legal Business Name): JENNA K HORTON WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD
ALBANY NY
12208-1742
US

IV. Provider business mailing address

PO BOX 14890 SPHP PAYER CREDENTIALING
ALBANY NY
12212
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-1019
  • Fax:
Mailing address:
  • Phone: 518-435-2443
  • Fax: 518-649-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: