Provider Demographics
NPI:1477170272
Name:HORNBERGER, KALEIGH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KALEIGH
Middle Name:
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 DAPHNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4298
Mailing Address - Country:US
Mailing Address - Phone:251-625-2663
Mailing Address - Fax:
Practice Address - Street 1:1505 DAPHNE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4298
Practice Address - Country:US
Practice Address - Phone:251-625-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily