Healthcare Provider Details

I. General information

NPI: 1497612121
Provider Name (Legal Business Name): WILLIAM NICHOLAS VAN HORN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD
LYONS NY
14489-9133
US

IV. Provider business mailing address

297 VALLEY RD
ROCHESTER NY
14618-2511
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax:
Mailing address:
  • Phone: 843-315-5094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: