Provider Demographics
NPI:1083500367
Name:HORTON, MATA ALLISON GAMBLE (RN)
Entity type:Individual
Prefix:MRS
First Name:MATA ALLISON
Middle Name:GAMBLE
Last Name:HORTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:GAMBLE
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2621 LYNCHBURG HWY
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29080-8309
Mailing Address - Country:US
Mailing Address - Phone:803-410-0083
Mailing Address - Fax:
Practice Address - Street 1:2621 LYNCHBURG HWY
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:SC
Practice Address - Zip Code:29080-8309
Practice Address - Country:US
Practice Address - Phone:803-410-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC245778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse