MEDICARE: AMY SUZANNE HORNER APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	125408	AR

General Provider Information

NPI Number	:	1659964153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SUZANNE HORNER APN

Provider Business Mailing Address
First Line	:	PO BOX 26618
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72221-6601
Country	:	US
Telephone Number	:	501-747-2828
Fax Number	:	501-474-2868

Provider Business Practice Location Address
First Line	:	10915 N RODNEY PARHAM RD STE B
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72212-4202
Country	:	US
Telephone Number	:	501-747-2828
Fax Number	:	501-747-2868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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