Provider Demographics
NPI:1154496974
Name:HORNE, KATHLEEN JO (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JO
Last Name:HORNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1006
Mailing Address - Country:US
Mailing Address - Phone:806-876-0338
Mailing Address - Fax:806-687-4326
Practice Address - Street 1:3801 21ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1006
Practice Address - Country:US
Practice Address - Phone:806-687-0338
Practice Address - Fax:806-687-4326
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant