Provider Demographics
NPI:1386890671
Name:HORNE, KAREN JOHNSON (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JOHNSON
Last Name:HORNE
Suffix:
Gender:F
Credentials:MD
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-333-4104
Mailing Address - Fax:704-358-4544
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:STE 512
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-333-4104
Practice Address - Fax:704-358-4544
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01378207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program