Provider Demographics
NPI:1437695426
Name:HORN, SARAH ELYSE (MS, RDN, CSOWM, LD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELYSE
Last Name:HORN
Suffix:
Gender:F
Credentials:MS, RDN, CSOWM, LD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELYSE
Other - Last Name:GALICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:3509 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1307
Mailing Address - Country:US
Mailing Address - Phone:806-799-7928
Mailing Address - Fax:806-788-8502
Practice Address - Street 1:3611 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-771-2222
Practice Address - Fax:806-771-2224
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4247876Medicaid
TX8PS909OtherBCBS