Provider Demographics
NPI:1205912987
Name:HORN, W RICHARD (FNP)
Entity type:Individual
Prefix:
First Name:W
Middle Name:RICHARD
Last Name:HORN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:STE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9385
Mailing Address - Country:US
Mailing Address - Phone:480-275-4941
Mailing Address - Fax:480-588-5156
Practice Address - Street 1:2451 EAST BASELINE RD.
Practice Address - Street 2:SUITE 425
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2471
Practice Address - Country:US
Practice Address - Phone:480-275-4941
Practice Address - Fax:480-588-5156
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN093072163WE0003X
AZAP2003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency