Provider Demographics
NPI:1508566803
Name:HORNSBY, JEREMIAH (FNP)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 RIDGECREST LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41017-9713
Mailing Address - Country:US
Mailing Address - Phone:513-828-2009
Mailing Address - Fax:
Practice Address - Street 1:3457 VALLEY PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:FORT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3019122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily