MEDICARE: MRS. CHRISTINE MARIE DALTON NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3006894	KY

General Provider Information

NPI Number	:	1659660470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE MARIE DALTON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	501 DARBY CREEK RD STE 11
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1605
Country	:	US
Telephone Number	:	859-338-0466
Fax Number	:	859-294-0802

Provider Business Practice Location Address
First Line	:	501 DARBY CREEK RD STE 11
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1605
Country	:	US
Telephone Number	:	859-338-0466
Fax Number	:	859-294-0802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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