Provider Demographics
NPI:1649957150
Name:ROWLETT, DALTON SCOTT (PA-C)
Entity type:Individual
Prefix:MR
First Name:DALTON
Middle Name:SCOTT
Last Name:ROWLETT
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1411 S CREASY LN STE 120
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7433
Mailing Address - Country:US
Mailing Address - Phone:765-447-4165
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:1411 S CREASY LN STE 120
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7433
Practice Address - Country:US
Practice Address - Phone:765-447-4165
Practice Address - Fax:765-446-5317
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10004356A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant