Provider Demographics
NPI:1386929974
Name:HORNER, KENNETH LEE (DPH)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEE
Last Name:HORNER
Suffix:
Gender:M
Credentials:DPH
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 157
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-0157
Mailing Address - Country:US
Mailing Address - Phone:731-352-3275
Mailing Address - Fax:
Practice Address - Street 1:102 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5414
Practice Address - Country:US
Practice Address - Phone:731-641-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist