MEDICARE: JAMES A DALTON PA-C

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	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	PA682	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970019230	OTHER	KY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790788180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A DALTON PA-C

Provider Business Mailing Address
First Line	:	1573 MALLORY LN
Second Line	:	STE 100
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2895
Country	:	US
Telephone Number	:	615-221-3855
Fax Number	:	615-221-1484

Provider Business Practice Location Address
First Line	:	1279 OLD ABBOTT MOUNTAIN RD
Second Line	:
City	:	PRESTONSBURG
State	:	KY
Zip	:	41653
Country	:	US
Telephone Number	:	606-886-0892
Fax Number	:	606-886-9746

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/12/2021

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Directions to “ JAMES A DALTON PA-C” Practice Location

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