Healthcare Provider Details

I. General information

NPI: 1790357986
Provider Name (Legal Business Name): AMY HALSTEAD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 KODIAK DR UNIT 202
BASALT CO
81621-8130
US

IV. Provider business mailing address

141 KODIAK DR UNIT 202
BASALT CO
81621-8130
US

V. Phone/Fax

Practice location:
  • Phone: 970-279-1472
  • Fax:
Mailing address:
  • Phone: 970-279-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996693-NP
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNONE
Identifier TypeOTHER
Identifier State
Identifier IssuerNONE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: