Provider Demographics
NPI:1518517234
Name:HORN, KRISTEN L (MED, RBT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:HORN
Suffix:
Gender:F
Credentials:MED, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 SADDLE LN
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471-6229
Mailing Address - Country:US
Mailing Address - Phone:863-227-6495
Mailing Address - Fax:
Practice Address - Street 1:1362 SADDLE LN
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-6229
Practice Address - Country:US
Practice Address - Phone:863-227-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-92528106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty