Provider Demographics
NPI:1720590904
Name:HORNEY, KRISTAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:HORNEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:
Other - Last Name:HINRICHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7638
Mailing Address - Country:US
Mailing Address - Phone:619-645-6045
Mailing Address - Fax:
Practice Address - Street 1:1501 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7638
Practice Address - Country:US
Practice Address - Phone:619-645-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily