1164430740 NPI number — AMY L HORNER PA-C

Table of content: AMY L HORNER PA-C (NPI 1164430740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164430740 NPI number — AMY L HORNER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNER
Provider First Name:
AMY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
AMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164430740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-364-1507
Provider Business Mailing Address Fax Number:
816-364-5711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2617 BURRIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64468-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-562-7546
Provider Business Practice Location Address Fax Number:
660-562-2266
Provider Enumeration Date:
08/03/2006

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: 363AM0700X , with the licence number:  2011026854 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9118676 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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