1083948855 NPI number — MS. KATHERINE ALEXANDRA VAN HORNE NP

Table of content: MS. KATHERINE ALEXANDRA VAN HORNE NP (NPI 1083948855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083948855 NPI number — MS. KATHERINE ALEXANDRA VAN HORNE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN HORNE
Provider First Name:
KATHERINE
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORVAL
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ALEXANDRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083948855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 ROSE ST
Provider Second Line Business Mailing Address:
CC180 A ROACH BUILDING
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-2753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ROSE ST
Provider Second Line Business Practice Location Address:
CC180 A ROACH BUILDING
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-2753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  RN278940 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 278940 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 3007110 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110083789A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".