Provider Demographics
NPI:1760364905
Name:HORNER, AMANDA LEA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:HORNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11886 PRAIRIE CIR
Mailing Address - Street 2:N/A
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021
Mailing Address - Country:US
Mailing Address - Phone:918-766-3575
Mailing Address - Fax:
Practice Address - Street 1:11886 PRAIRIE CIR
Practice Address - Street 2:N/A
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-7402
Practice Address - Country:US
Practice Address - Phone:918-766-3575
Practice Address - Fax:918-766-3575
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator