Provider Demographics
NPI:1528499761
Name:HORN, MADELINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1187
Mailing Address - Country:US
Mailing Address - Phone:740-779-4000
Mailing Address - Fax:
Practice Address - Street 1:55 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1187
Practice Address - Country:US
Practice Address - Phone:740-779-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9324604163W00000X
OHRN373859163W00000X
FLAPRN9324604363L00000X
OHCOA.15661-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX259ZMedicare PIN