Provider Demographics
NPI:1073670493
Name:WILSON-HORNEY, KATHRYN DIANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:DIANA
Last Name:WILSON-HORNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4181
Mailing Address - Country:US
Mailing Address - Phone:843-376-5348
Mailing Address - Fax:843-353-2605
Practice Address - Street 1:4340 LADSON RD
Practice Address - Street 2:SUITE C
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-851-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA36930281OtherMEDICARE PTAN
SCAA36930281OtherMEDICARE PTAN