Provider Demographics
NPI:1467452540
Name:HORTON, IRIS A (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:A
Last Name:HORTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:275 HWY 770
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4732
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN027825367500000X
KY1109859367500000X
KY4909A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000484172OtherBLUE CROSS/BLUE SHIELD
TN3602454Medicaid
KYP00336403OtherRAILROAD MEDICARE PIN
KY74278250Medicaid
KY000000484172OtherANTHEM BCBS KY
TN3057362OtherBCBS NUMBER
KY000000484172OtherANTHEM BCBS KY
TN3602455Medicare ID - Type Unspecified