Provider Demographics
NPI:1790788180
Name:DALTON, JAMES A (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DALTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 MALLORY LN
Mailing Address - Street 2:STE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2895
Mailing Address - Country:US
Mailing Address - Phone:615-221-3855
Mailing Address - Fax:615-221-1484
Practice Address - Street 1:1279 OLD ABBOTT MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-0892
Practice Address - Fax:606-886-9746
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KYPA682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY970019230OtherMEDICARE RAILROAD
KY363A00000XMedicaid
OH0072290Medicaid
KY95001673Medicaid
KYK0077312Medicare PIN
P39422Medicare UPIN
KY0257213Medicare PIN
KYP00680087Medicare PIN
KY363A00000XMedicaid
KYP01317679Medicare PIN
KY00788003Medicare PIN