Provider Demographics
NPI:1861650319
Name:DAYTON, KACEY LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KACEY
Middle Name:LYNN
Last Name:DAYTON
Suffix:
Gender:F
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 1:1230 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1602
Mailing Address - Country:US
Mailing Address - Phone:312-666-0028
Mailing Address - Fax:312-666-5214
Practice Address - Street 1:1230 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1602
Practice Address - Country:US
Practice Address - Phone:312-666-0028
Practice Address - Fax:312-666-5214
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant