Provider Demographics
NPI:1558019638
Name:WALTON, BREANA (APN, RXN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:APN, RXN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WELTON ST APT 816
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3885
Mailing Address - Country:US
Mailing Address - Phone:303-356-9576
Mailing Address - Fax:
Practice Address - Street 1:3280 E WOODMEN RD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3586
Practice Address - Country:US
Practice Address - Phone:719-445-6744
Practice Address - Fax:719-960-3135
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997342-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health