Healthcare Provider Details

I. General information

NPI: 1881695054
Provider Name (Legal Business Name): JENNIFER ALEXIS HORTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 SKIPWITH RD
HENRICO VA
23229-5253
US

IV. Provider business mailing address

PO BOX 7650
HENRICO VA
23231-0150
US

V. Phone/Fax

Practice location:
  • Phone: 804-507-1644
  • Fax: 804-507-0116
Mailing address:
  • Phone: 804-507-1644
  • Fax: 804-507-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200400359
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101244225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: