Brenda Horton, L. P. N.
Individual provider Active NPI Licensed Practical Nurse · New Site, MS
NPI 1629135751 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1629135751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- P205656 (MS)
- Practice address
- 390 County Road 3501
New Site, MS 38859-9579 - Phone
- (662) 728-5427
- NPI assigned
- Jan 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P205656 | MS | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | P205656 | MS | Yes |
Addresses
Primary practice location
390 County Road 3501
New Site, MS 38859-9579
Mailing address
390 County Road 3501
New Site, MS 38859-9579
Phone (662) 728-5427
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00770279 | Medicaid | MS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.