Provider Demographics
NPI:1083258347
Name:VAN HORN, RACHEL LAUREN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LAUREN
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:KILPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:706-258-4140
Mailing Address - Fax:706-258-4141
Practice Address - Street 1:101 RIVERSTONE VIS STE 102
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6630
Practice Address - Country:US
Practice Address - Phone:706-258-4140
Practice Address - Fax:706-258-4141
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003227602AMedicaid
GAG17324AOtherMEDICARE PTAN