Provider Demographics
NPI:1609277144
Name:HORNER, KATIE (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HORNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 COLEMAN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-2006
Mailing Address - Country:US
Mailing Address - Phone:701-354-0964
Mailing Address - Fax:701-354-0966
Practice Address - Street 1:4503 COLEMAN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-2006
Practice Address - Country:US
Practice Address - Phone:701-354-0964
Practice Address - Fax:701-354-0966
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner