Healthcare Provider Details

I. General information

NPI: 1770085946
Provider Name (Legal Business Name): KAITLYNN MARIE HORNSBY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYNN MARIE COTTRILL

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8200
  • Fax: 304-388-7010
Mailing address:
  • Phone: 304-388-8200
  • Fax: 304-388-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN81018-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: