Basic Information
| Provider Information | |||||||||
| NPI: | 1104321405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5195 REEDY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242021507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235576402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 58 CARROLL STREET | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2768838000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024176000 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.