Provider Demographics
NPI:1538462759
Name:HORTON, JENNIFER K (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:HORTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SCHILLER
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2885
Mailing Address - Country:US
Mailing Address - Phone:331-221-9000
Mailing Address - Fax:331-221-9015
Practice Address - Street 1:172 SCHILLER
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2885
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-9015
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003886363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical