Provider Demographics
NPI:1851073258
Name:HORNE, JACQUELINE (RD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BROOKLAWN TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1709
Mailing Address - Country:US
Mailing Address - Phone:203-482-7544
Mailing Address - Fax:
Practice Address - Street 1:544 RIVERSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5732
Practice Address - Country:US
Practice Address - Phone:203-557-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered