Provider Demographics
NPI:1497840680
Name:HORN, TARA R (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:R
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BOGLE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2870
Mailing Address - Country:US
Mailing Address - Phone:606-451-3145
Mailing Address - Fax:606-451-3149
Practice Address - Street 1:402 BOGLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2870
Practice Address - Country:US
Practice Address - Phone:606-451-3145
Practice Address - Fax:606-451-3149
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38630207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64085400Medicaid
KY1954001Medicare ID - Type Unspecified
KY64085400Medicaid