Provider Demographics
NPI:1366827917
Name:DAULTON, AARON BRENT
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BRENT
Last Name:DAULTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668-0125
Mailing Address - Country:US
Mailing Address - Phone:417-745-2121
Mailing Address - Fax:
Practice Address - Street 1:18614 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:MO
Practice Address - Zip Code:65668-8204
Practice Address - Country:US
Practice Address - Phone:417-745-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015025660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily