Provider Demographics
NPI:1801430731
Name:HORN, HAROLD GREGORY (APRN)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:GREGORY
Last Name:HORN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N MAYO TRL STE 3
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1811
Mailing Address - Country:US
Mailing Address - Phone:606-789-3188
Mailing Address - Fax:606-789-3190
Practice Address - Street 1:520 N MAYO TRL STE 3
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1811
Practice Address - Country:US
Practice Address - Phone:606-789-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100636340Medicaid