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General NPI Number Information
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NPI Number | 1619968542
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Entity Type | Individual
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Provider Name | DALTREY ANNE TYREE PMHNP, APRN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 730 FAIRVIEW AVE STE B3
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2365
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Country | US
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Telephone | 270-715-0665
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Fax | 270-550-2008
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Provider Business Mailing Address
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Address Line | 730 FAIRVIEW AVE STE B3
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2365
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Country | US
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Telephone | 270-715-0665
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Fax | 270-550-2008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4688P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3004688
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License Number State | KY
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