Provider Demographics
NPI:1376119248
Name:HORNADY, RUTH MELODY (APRN, AGACNP)
Entity Type:Individual
Prefix:
First Name:RUTH MELODY
Middle Name:
Last Name:HORNADY
Suffix:
Gender:F
Credentials:APRN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W MARFA AVE
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-1656
Mailing Address - Country:US
Mailing Address - Phone:832-630-6631
Mailing Address - Fax:
Practice Address - Street 1:2600 N, TX-118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX862147163WC0200X
TX1058619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine