Basic Information
| Provider Information | |||||||||
| NPI: | 1649239880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNE | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | BRANTLEY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 HAWTHORNE PARK CT | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296153194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646035600 | ||||||||
| FaxNumber: | 8646035601 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 HARRISON BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296807133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646035600 | ||||||||
| FaxNumber: | 8646035601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2203 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NP0906 | 05 | SC | MEDICAID |