Provider Demographics
NPI:1114464963
Name:HORTON, KIMBERLY NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:HORTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NICHOLE
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-0811
Mailing Address - Country:US
Mailing Address - Phone:276-266-3134
Mailing Address - Fax:
Practice Address - Street 1:1141 W STUART DR
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1593
Practice Address - Country:US
Practice Address - Phone:276-266-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily