Healthcare Provider Details

I. General information

NPI: 1477002707
Provider Name (Legal Business Name): CAROLYN HORTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 JACKSON PIKE
COLUMBUS OH
43223-3847
US

IV. Provider business mailing address

2090 COLUMBIANA RD STE 4000
BIRMINGHAM AL
35216
US

V. Phone/Fax

Practice location:
  • Phone: 614-525-7616
  • Fax:
Mailing address:
  • Phone: 205-536-8400
  • Fax: 205-536-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004855RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.004855RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: