Healthcare Provider Details

I. General information

NPI: 1831663327
Provider Name (Legal Business Name): STEPHANIE NICOLE DALTON CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 YORKSHIRE MEDICAL PARK
LEXINGTON KY
40509-1886
US

IV. Provider business mailing address

2229 REDBUD LN
PARIS KY
40361-2435
US

V. Phone/Fax

Practice location:
  • Phone: 859-707-1104
  • Fax:
Mailing address:
  • Phone: 859-707-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number4503
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: