Provider Demographics
NPI:1083948855
Name:VAN HORNE, KATHERINE ALEXANDRA (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ALEXANDRA
Last Name:VAN HORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ALEXANDRA
Other - Last Name:DORVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:CC180 A ROACH BUILDING
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0093
Mailing Address - Country:US
Mailing Address - Phone:859-323-2753
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:CC180 A ROACH BUILDING
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-323-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN278940363LA2100X
MA278940363L00000X
KY3007110363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083789AMedicaid
MA001353801Medicare PIN