Healthcare Provider Details

I. General information

NPI: 1760446827
Provider Name (Legal Business Name): JAMES ALFRED HORN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD SUITE 3
CROSS LANES WV
25313-6602
US

IV. Provider business mailing address

415 MORRIS ST SUITE 304
CHARLESTON WV
25301-1842
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7070
  • Fax: 304-388-7075
Mailing address:
  • Phone: 304-388-7782
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0082950-22 (FNP)
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: