Provider Demographics
NPI: | 1861815425 |
---|---|
Name: | HORTON, SHANQUAIL DARNYSSE (CRNP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | SHANQUAIL |
Middle Name: | DARNYSSE |
Last Name: | HORTON |
Suffix: | |
Gender: | F |
Credentials: | CRNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 11889 GLEN RIDGE BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | MOUNDVILLE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35474-6368 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-561-7724 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11889 GLEN RIDGE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | MOUNDVILLE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35474-6368 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-561-7724 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-01-31 |
Last Update Date: | 2014-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 1-127996 | 163W00000X |
AL | 2013015363 | 363LA2200X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |