MEDICARE: VALARIE DALTON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	20424	TN

General Provider Information

NPI Number	:	1881062040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALARIE DALTON FNP-BC

Provider Business Mailing Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:	SUITE 201
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:	SUITE 201
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	05/06/2016

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