Dalton, Kelly Marie

Dalton, Kelly Marie is an individual health care provider with primary practice located at 1235 E Cherokee St , Springfield MO 65804-2203. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Dalton, Kelly Marie can be contacted via phone (417) 820-3911.

Contact Information

Primary practice address
1235 E Cherokee St Springfield MO 65804-2203
Phone: (417) 820-3911
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 2020009164 Missouri

Profile Details

NPI number 1770119372
LBN Legal business name Dalton, Kelly Marie
Credentials AGACNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2020
Last updated Jan 10th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770119372 NPPES
Missouri MEDICAID 420081844

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