Healthcare Provider Details

I. General information

NPI: 1760626402
Provider Name (Legal Business Name): LINDA DALTON KEITH F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 2ND ST
HENDERSON KY
42420
US

IV. Provider business mailing address

PO BOX 1099
OWENSBORO KY
42302-1099
US

V. Phone/Fax

Practice location:
  • Phone: 270-826-4433
  • Fax: 270-826-4222
Mailing address:
  • Phone: 270-295-3890
  • Fax: 270-295-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003103A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005994
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: