Basic Information
| Provider Information | |||||||||
| NPI: | 1578603452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | TAWN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 E SHADY LN | ||||||||
| Address2: | |||||||||
| City: | AU GRES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487039753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898762427 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3210 E HURON RD | ||||||||
| Address2: | |||||||||
| City: | AU GRES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487039322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898767104 | ||||||||
| FaxNumber: | 9898762881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601002327 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.