Provider Demographics
NPI:1770995102
Name:HORN, KATORRIA LAKEISHA (LPN, EMT-B)
Entity type:Individual
Prefix:
First Name:KATORRIA
Middle Name:LAKEISHA
Last Name:HORN
Suffix:
Gender:F
Credentials:LPN, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2816
Mailing Address - Country:US
Mailing Address - Phone:804-325-0418
Mailing Address - Fax:877-216-7678
Practice Address - Street 1:421 HUNT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2816
Practice Address - Country:US
Practice Address - Phone:804-325-0418
Practice Address - Fax:877-216-7678
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002072601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse