=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588011894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAMEA HORTON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2016
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2727 BOLTON BOONE DR STE 110
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-685-2494
-----------------------------------------------------
Fax | 972-739-2436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 BOLTON BOONE DR STE 110
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-685-2494
-----------------------------------------------------
Fax | 862-298-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP130984
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------