Individual
NICHOLE C HORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5010
(601) 579-3067
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00117
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02285303
—
MS
01
—
1229636
CIGNA
MS
01
—
9843426
AETNA
MS
01
—
P00775212
RAILROAD MEDICARE
MS
Enumeration date
07/27/2009
Last updated
03/11/2016
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