Provider Demographics
NPI:1316545254
Name:HALTON, BRENDA S (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:S
Last Name:HALTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 LOVETT STREET
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1166
Mailing Address - Country:US
Mailing Address - Phone:314-401-7854
Mailing Address - Fax:
Practice Address - Street 1:1010 WEST COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640
Practice Address - Country:US
Practice Address - Phone:573-218-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022573363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health