Provider Demographics
NPI:1194439067
Name:HORTON, KEVIN SR
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HORTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 S SALIDA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1977
Mailing Address - Country:US
Mailing Address - Phone:571-268-7386
Mailing Address - Fax:
Practice Address - Street 1:4575 S SALIDA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1977
Practice Address - Country:US
Practice Address - Phone:571-268-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20228237900OtherSTATE OF COLORADO