Provider Demographics
NPI:1184619520
Name:DALTON, PATRICIA J (FNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:DALTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FORT RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4901
Mailing Address - Country:US
Mailing Address - Phone:325-654-5955
Mailing Address - Fax:
Practice Address - Street 1:590 MITCHELL BLVD BLDG 375
Practice Address - Street 2:
Practice Address - City:LAUGHLIN AFB
Practice Address - State:TX
Practice Address - Zip Code:78843-5242
Practice Address - Country:US
Practice Address - Phone:830-298-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily