1841601713 NPI number — LAURA MICHELLE HORNSBY CSW

Table of content: LAURA MICHELLE HORNSBY CSW (NPI 1841601713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841601713 NPI number — LAURA MICHELLE HORNSBY CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNSBY
Provider First Name:
LAURA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841601713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 N DIXIE HWY STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-4650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-853-1016
Provider Business Mailing Address Fax Number:
270-735-9848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 N DIXIE HWY STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-4650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-853-1016
Provider Business Practice Location Address Fax Number:
270-735-9848
Provider Enumeration Date:
05/14/2014

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: 101Y00000X , with the licence number:  6225 , 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)