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NPI Code Detail

MEDICARE: JAMES A DALTON PA-C

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
1363A00000XPhysician Assistant
2363AM0700XMedical Physician AssistantPA682KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970019230OTHERKYMEDICARE RAILROAD

Other Identifiers

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