Provider Demographics
NPI:1992245534
Name:HORNE, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HORNE
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:PO BOX 852581
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-2581
Mailing Address - Country:US
Mailing Address - Phone:469-917-7566
Mailing Address - Fax:
Practice Address - Street 1:909 E DAVIS ST
Practice Address - Street 2:D
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4777
Practice Address - Country:US
Practice Address - Phone:469-917-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT031739173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist