Provider Demographics
NPI:1679551402
Name:HORNE, KEVIN JAY (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAY
Last Name:HORNE
Suffix:
Gender:M
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9782 HWY 903
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1991
Mailing Address - Country:US
Mailing Address - Phone:434-636-6903
Mailing Address - Fax:434-636-3826
Practice Address - Street 1:9782 HWY 903
Practice Address - Street 2:
Practice Address - City:BRACEY
Practice Address - State:VA
Practice Address - Zip Code:23919-1991
Practice Address - Country:US
Practice Address - Phone:434-636-6903
Practice Address - Fax:434-636-3826
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080106064OtherRAILROAD MEDICARE #
NC5131201OtherCCN/FIRST HEALTH #
NC84854OtherMEDCOST LLC PROVIDER #
VAP01159044OtherRAILROAD MEDICARE
VA0024169059OtherVA LICENSE #
NC200823OtherNC MEDICAL LICENSE #
NC200823OtherNC MEDICAL LICENSE #
VA0024169059OtherVA LICENSE #
VAP01159044OtherRAILROAD MEDICARE