Healthcare Provider Details

I. General information

NPI: 1437695426
Provider Name (Legal Business Name): SARAH ELYSE HORN MS, RDN, CSOWM, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ELYSE GALICKI MS, RDN

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 22ND PL
LUBBOCK TX
79410
US

IV. Provider business mailing address

3509 22ND ST
LUBBOCK TX
79410-1307
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-2222
  • Fax: 806-771-2224
Mailing address:
  • Phone: 806-799-7928
  • Fax: 806-788-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT84320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: