Provider Demographics
NPI:1316223316
Name:HORNER, TABATHA L (NP)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:L
Last Name:HORNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4543
Mailing Address - Country:US
Mailing Address - Phone:336-599-9257
Mailing Address - Fax:336-599-2716
Practice Address - Street 1:609 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4543
Practice Address - Country:US
Practice Address - Phone:336-599-9257
Practice Address - Fax:336-599-2716
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily