Provider Demographics
NPI:1497455018
Name:HORNSBY, CAITLYN MARTHA GRACE
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARTHA GRACE
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-0212
Mailing Address - Country:US
Mailing Address - Phone:361-528-3262
Mailing Address - Fax:
Practice Address - Street 1:1210 GREGORY ST STE 3
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-3045
Practice Address - Country:US
Practice Address - Phone:361-528-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TX395831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program