Provider Demographics
NPI:1619908910
Name:HORNSBY, KEVIN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARTIN
Last Name:HORNSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 TINDIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-5544
Mailing Address - Country:US
Mailing Address - Phone:407-615-9974
Mailing Address - Fax:
Practice Address - Street 1:4415 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-6307
Practice Address - Country:US
Practice Address - Phone:850-951-4556
Practice Address - Fax:850-951-4527
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87878207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103754700Medicaid
AL529802110Medicaid