Provider Demographics
NPI:1235530825
Name:HORTON, LOVIKA
Entity Type:Individual
Prefix:
First Name:LOVIKA
Middle Name:
Last Name:HORTON
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 1:2153 VALLEYGATE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3667
Mailing Address - Country:US
Mailing Address - Phone:910-321-7246
Mailing Address - Fax:910-321-7245
Practice Address - Street 1:801 SUMMIT AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7813
Practice Address - Country:US
Practice Address - Phone:336-907-4345
Practice Address - Fax:336-907-4935
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007156363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235530825Medicaid