Basic Information
| Provider Information | |||||||||
| NPI: | 1982074274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORTON | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | C.N.M., R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2606 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554073706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125455311 | ||||||||
| FaxNumber: | 6122249622 | ||||||||
| Practice Location | |||||||||
| Address1: | 2606 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125455311 | ||||||||
| FaxNumber: | 6122249622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNM389 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.