Wanda L Horn, MHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

126560 Issued in MO

Practice address

612 State Highway 25 S
Bloomfield, MO 63825-9566

Phone

(573) 803-3995

Fax

(573) 803-5222

NPI assigned

May 19, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1750600524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 HWY 25 SOUTH",
            "city": "BLOOMFIELD",
            "state": "MO",
            "postal_code": "638259566",
            "telephone_number": "573-568-7377",
            "fax_number": "573-568-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 STATE HIGHWAY 25 S",
            "city": "BLOOMFIELD",
            "state": "MO",
            "postal_code": "638259566",
            "telephone_number": "573-803-3995",
            "fax_number": "573-803-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 BROADWAY ST",
            "address_purpose": "LOCATION",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015514",
            "country_code": "US",
            "telephone_number": "573-837-1124",
            "fax_number": "573-803-5222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HORN",
        "first_name": "WANDA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "MHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-19",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "126560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE BOARD OF NURSING LICENSE",
            "identifier": "126560",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Bloomfield, MO
• Providers in Bloomfield, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.