Provider Demographics
NPI:1306236799
Name:HORN, HALEY A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:A
Last Name:HORN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 E STATE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6377
Mailing Address - Country:US
Mailing Address - Phone:208-607-3738
Mailing Address - Fax:208-369-9274
Practice Address - Street 1:2976 E STATE ST STE 210
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6377
Practice Address - Country:US
Practice Address - Phone:208-607-3738
Practice Address - Fax:208-369-9274
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10033534363LP0808X, 163W00000X
ID8861970363LP0808X
ID7761478163W00000X
CA780214163W00000X
CA95001451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty