Provider Demographics
NPI:1619675766
Name:DALTON, REBECCA JEAN (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:DALTON
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1659
Mailing Address - Country:US
Mailing Address - Phone:573-586-6999
Mailing Address - Fax:
Practice Address - Street 1:807 COLLINS DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2346
Practice Address - Country:US
Practice Address - Phone:636-931-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010026038163WP0809X
MO2023006443363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult