Provider Demographics
NPI:1760446827
Name:HORN, JAMES ALFRED (FNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALFRED
Last Name:HORN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1842
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:314 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-6602
Practice Address - Country:US
Practice Address - Phone:304-388-7070
Practice Address - Fax:304-388-7075
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0082950-22 (FNP)363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000447Medicaid
WV3810000447Medicaid
WVHONP16151Medicare ID - Type Unspecified
WVQ23066Medicare UPIN