Provider Demographics
NPI:1508842709
Name:DALTON, JAMI (RNCSFNP)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:RNCSFNP
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:
Other - Last Name:BURLINGAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNCSFNP
Mailing Address - Street 1:607 BIG HORN DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6944
Mailing Address - Country:US
Mailing Address - Phone:660-341-6289
Mailing Address - Fax:
Practice Address - Street 1:601 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1605
Practice Address - Country:US
Practice Address - Phone:660-465-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO426043105Medicaid
MO426043105Medicaid