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
StateLicense IDTaxonomies
AL1-127996163W00000X
AL2013015363363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health