Healthcare Provider Details

I. General information

NPI: 1841740164
Provider Name (Legal Business Name): MANDY HORNE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 OMEGA DR
ARLINGTON TX
76014-2004
US

IV. Provider business mailing address

505 OMEGA DR
ARLINGTON TX
76014-2004
US

V. Phone/Fax

Practice location:
  • Phone: 817-468-3255
  • Fax: 817-468-7823
Mailing address:
  • Phone: 817-468-3255
  • Fax: 817-468-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP132194
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP132194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: