Provider Demographics
NPI:1679245674
Name:DALTON, KRISTA (RN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-7500
Mailing Address - Country:US
Mailing Address - Phone:732-870-7494
Mailing Address - Fax:
Practice Address - Street 1:127 JOHNNY CAKE HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5674
Practice Address - Country:US
Practice Address - Phone:401-846-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN70441163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health