Provider Demographics
NPI:1881653079
Name:HORNSBY, MARK A (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:HORNSBY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-1130
Mailing Address - Country:US
Mailing Address - Phone:806-592-2121
Mailing Address - Fax:806-592-5489
Practice Address - Street 1:412 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2762
Practice Address - Country:US
Practice Address - Phone:806-592-2121
Practice Address - Fax:806-592-5489
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2773367500000X
TXAP112316367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184258501Medicaid
TX86896UOtherBCBSTX
CARN5543380Medicaid
TX1D4636OtherNOVITAS - 855I
TX1D4636Other855R