Healthcare Provider Details

I. General information

NPI: 1013091065
Provider Name (Legal Business Name): MARY BETH HORST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WESTLAKE RD
HARDY VA
24101-3967
US

IV. Provider business mailing address

282 WESTLAKE RD
HARDY VA
24101-3967
US

V. Phone/Fax

Practice location:
  • Phone: 540-721-2689
  • Fax: 540-721-3718
Mailing address:
  • Phone: 540-721-2689
  • Fax: 540-721-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024165688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: