1114464963 NPI number — MRS. KIMBERLY NICHOLE HORTON FNP

Table of content: MRS. KIMBERLY NICHOLE HORTON FNP (NPI 1114464963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114464963 NPI number — MRS. KIMBERLY NICHOLE HORTON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORTON
Provider First Name:
KIMBERLY
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWDER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114464963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 811
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24343-0811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-266-3134
Provider Business Mailing Address Fax Number:
276-266-3086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 TRAINING CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAWN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24381-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-266-3134
Provider Business Practice Location Address Fax Number:
276-266-3086
Provider Enumeration Date:
01/31/2017

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: 363LF0000X , with the licence number:  0024174449 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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