Provider Demographics
NPI:1265413330
Name:DAYTON, KOLLEEN MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:KOLLEEN
Middle Name:MARIE
Last Name:DAYTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51520 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8213
Mailing Address - Country:US
Mailing Address - Phone:740-449-2175
Mailing Address - Fax:740-449-2268
Practice Address - Street 1:51520 NATIONAL RD EAST
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8213
Practice Address - Country:US
Practice Address - Phone:740-449-2175
Practice Address - Fax:740-449-2268
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37047363LF0000X
OH05431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP11757Medicare UPIN
WV96000253000Medicaid
WVNP06251Medicare ID - Type Unspecified