Provider Demographics
NPI:1306479217
Name:HORNE, KELSEY ALEXIS
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALEXIS
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-0572
Mailing Address - Country:US
Mailing Address - Phone:440-731-7388
Mailing Address - Fax:
Practice Address - Street 1:413 AUBURN ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8293
Practice Address - Country:US
Practice Address - Phone:440-371-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant