Provider Demographics
NPI:1811580822
Name:HORN II, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HORN II
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2216 3RD ST
Practice Address - Street 2:
Practice Address - City:CULLODEN
Practice Address - State:WV
Practice Address - Zip Code:25510-9729
Practice Address - Country:US
Practice Address - Phone:304-444-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker