Provider Demographics
NPI:1740590363
Name:HORTON, KIMBERLY CAROL LONG (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CAROL LONG
Last Name:HORTON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:CAROL
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:1411 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-535-7582
Mailing Address - Fax:510-535-7759
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-535-7582
Practice Address - Fax:510-535-7759
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9856363LF0000X
CA245364SC2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care