Provider Demographics
NPI:1659964153
Name:HORNER, AMY SUZANNE (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:HORNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26618
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6601
Mailing Address - Country:US
Mailing Address - Phone:501-747-2828
Mailing Address - Fax:501-474-2868
Practice Address - Street 1:10915 N RODNEY PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4202
Practice Address - Country:US
Practice Address - Phone:501-747-2828
Practice Address - Fax:501-747-2868
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner