Provider Demographics
NPI:1164062998
Name:MORTON, DUSTIN SHANE (PMHNP)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:SHANE
Last Name:MORTON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-4176
Mailing Address - Country:US
Mailing Address - Phone:573-664-1047
Mailing Address - Fax:573-218-0716
Practice Address - Street 1:203 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1836
Practice Address - Country:US
Practice Address - Phone:573-330-7686
Practice Address - Fax:573-218-0716
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020004280363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health