Healthcare Provider Details

I. General information

NPI: 1841104791
Provider Name (Legal Business Name): DALTON DEL MONROE SIBLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NICHOLAS ST APT B-H
ELIZABETHTOWN KY
42701-9242
US

IV. Provider business mailing address

951 NICHOLAS ST APT B-H
ELIZABETHTOWN KY
42701-9242
US

V. Phone/Fax

Practice location:
  • Phone: 629-333-5840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number1124793
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: