Individual
KELLY MARIE DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-3911
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-3911
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2020009164
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420081844
—
MO
Enumeration date
03/16/2020
Last updated
01/10/2023
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