Healthcare Provider Details

I. General information

NPI: 1730975293
Provider Name (Legal Business Name): HUNTER BLAKE HORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S MAIN ST
CROSSVILLE TN
38555-5048
US

IV. Provider business mailing address

105 BOXWOOD CIR
KINGSPORT TN
37663-3574
US

V. Phone/Fax

Practice location:
  • Phone: 423-773-4462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6569
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: