Provider Demographics
NPI:1780639302
Name:HORGER, KRISHA (NP)
Entity Type:Individual
Prefix:
First Name:KRISHA
Middle Name:
Last Name:HORGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 W M 21 STE 104
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8164
Mailing Address - Country:US
Mailing Address - Phone:989-725-8171
Mailing Address - Fax:989-723-1257
Practice Address - Street 1:1975 W M 21 STE 104
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8164
Practice Address - Country:US
Practice Address - Phone:989-725-8171
Practice Address - Fax:989-723-1257
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704207734207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780639302Medicaid
MIN90910009Medicare PIN
MI1780639302Medicaid
G53882Medicare UPIN
MI0P19930Medicare PIN