Provider Demographics
NPI:1154835262
Name:VANHORN, KRISTON
Entity Type:Individual
Prefix:
First Name:KRISTON
Middle Name:
Last Name:VANHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1338
Mailing Address - Country:US
Mailing Address - Phone:304-759-9835
Mailing Address - Fax:304-759-9839
Practice Address - Street 1:824 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1338
Practice Address - Country:US
Practice Address - Phone:304-759-9835
Practice Address - Fax:304-759-9839
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator