Provider Demographics
NPI:1013761923
Name:HORNER, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HORNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2736
Mailing Address - Country:US
Mailing Address - Phone:740-357-3415
Mailing Address - Fax:
Practice Address - Street 1:2723 S WILLOW WAY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2736
Practice Address - Country:US
Practice Address - Phone:740-357-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide