Provider Demographics
NPI:1386341717
Name:HORNER, AMY
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:HORNER
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 1:5604 GARROW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3010
Mailing Address - Country:US
Mailing Address - Phone:502-751-4240
Mailing Address - Fax:
Practice Address - Street 1:1028 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1667
Practice Address - Country:US
Practice Address - Phone:502-451-1221
Practice Address - Fax:502-451-1337
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY2590551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program