Provider Demographics
NPI:1184822009
Name:DALTON, CAROLYN MCKINSEY
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MCKINSEY
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 WOODDALE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1517
Mailing Address - Country:US
Mailing Address - Phone:225-302-7729
Mailing Address - Fax:225-330-4785
Practice Address - Street 1:1986 DALLAS DR
Practice Address - Street 2:SUITE 9
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1400
Practice Address - Country:US
Practice Address - Phone:225-926-7570
Practice Address - Fax:225-926-7578
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA200385423OtherTAX ID