Provider Demographics
NPI:1295774024
Name:HORNE, KATHLEEN E (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:HORNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:409 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1918
Practice Address - Country:US
Practice Address - Phone:570-286-1482
Practice Address - Fax:570-286-5243
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009619L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017038380008Medicaid
PA013216Medicare PIN