Provider Demographics
NPI:1528464054
Name:HORN, KACEY JO (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:JO
Last Name:HORN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3115
Mailing Address - Country:US
Mailing Address - Phone:501-672-4732
Mailing Address - Fax:501-315-8434
Practice Address - Street 1:1889 FALCON WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3115
Practice Address - Country:US
Practice Address - Phone:501-672-4732
Practice Address - Fax:501-315-8434
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206200758Medicaid