Provider Demographics
NPI:1356631022
Name:MILTON, HENRETTA NESBITT (APRN, FPMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:HENRETTA
Middle Name:NESBITT
Last Name:MILTON
Suffix:
Gender:F
Credentials:APRN, FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SADDLERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4245
Mailing Address - Country:US
Mailing Address - Phone:803-419-4708
Mailing Address - Fax:
Practice Address - Street 1:105 SADDLERIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4245
Practice Address - Country:US
Practice Address - Phone:803-419-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCR 54531163WP0808X
SC17710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health