Provider Demographics
NPI:1689657850
Name:HORN, EVERETT J (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:J
Last Name:HORN
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:800 ROSE ST WHITNEY HENDRICKSON BLDG STE 331A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-4488
Practice Address - Fax:859-323-1018
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27279207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000815065OtherANTHEM BCBS
KY64272792Medicaid
KYF61092Medicare UPIN
KY64272792Medicaid
KY64272792Medicaid
KY0613003Medicare PIN
KY0612803Medicare PIN
KYF61092Medicare UPIN