Provider Demographics
NPI:1013091065
Name:HORST, MARY BETH (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HORST
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 1:282 WESTLAKE RD
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-3967
Mailing Address - Country:US
Mailing Address - Phone:540-721-2689
Mailing Address - Fax:540-721-3718
Practice Address - Street 1:282 WESTLAKE RD
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3967
Practice Address - Country:US
Practice Address - Phone:540-721-2689
Practice Address - Fax:540-721-3718
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010141508Medicaid
VA010141508Medicaid
VA007070M98Medicare ID - Type UnspecifiedC03698