Provider Demographics
NPI:1164430740
Name:HORNER, AMY L (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HORNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1419 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2459
Mailing Address - Country:US
Mailing Address - Phone:816-364-1507
Mailing Address - Fax:816-364-5711
Practice Address - Street 1:2617 BURRIS RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3607
Practice Address - Country:US
Practice Address - Phone:660-562-7546
Practice Address - Fax:660-562-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011026854363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9118676OtherFLORIDA MEDICAL LICENSE