Healthcare Provider Details

I. General information

NPI: 1255168902
Provider Name (Legal Business Name): MELISSA IVY DALTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SIMONS RUN
LYNCHBURG VA
24502-8911
US

IV. Provider business mailing address

1155 SIMONS RUN
LYNCHBURG VA
24502-8911
US

V. Phone/Fax

Practice location:
  • Phone: 434-287-5300
  • Fax:
Mailing address:
  • Phone: 434-287-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09240591
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: