Provider Demographics
NPI:1790246007
Name:HORTON, NATHANIAL L (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:L
Last Name:HORTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 N LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-3693
Mailing Address - Country:US
Mailing Address - Phone:816-651-2755
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1230
Practice Address - Street 2:
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-841-3805
Practice Address - Fax:816-214-9330
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant