Provider Demographics
NPI:1336873009
Name:HORTON, SHAWNTINA C
Entity Type:Individual
Prefix:
First Name:SHAWNTINA
Middle Name:C
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 NACONA DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5019
Mailing Address - Country:US
Mailing Address - Phone:972-974-6505
Mailing Address - Fax:
Practice Address - Street 1:1316 NACONA DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-5019
Practice Address - Country:US
Practice Address - Phone:972-974-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist