Provider Demographics
NPI:1497426936
Name:HORNE, CRYSTAL (FDN-P)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5535
Mailing Address - Country:US
Mailing Address - Phone:615-525-1291
Mailing Address - Fax:
Practice Address - Street 1:11620 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5535
Practice Address - Country:US
Practice Address - Phone:615-525-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date: