Provider Demographics
NPI:1205808128
Name:HORN, KEVIN (ARNP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HORN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 W DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3811
Mailing Address - Country:US
Mailing Address - Phone:386-755-5044
Mailing Address - Fax:386-755-2518
Practice Address - Street 1:311 NW 250TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4454
Practice Address - Country:US
Practice Address - Phone:352-472-6776
Practice Address - Fax:352-472-6778
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224044363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3065758000Medicaid