Basic Information
| Provider Information | |||||||||
| NPI: | 1720015423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 DONIPHAN DR | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648509120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174519450 | ||||||||
| FaxNumber: | 4174518903 | ||||||||
| Practice Location | |||||||||
| Address1: | 4016 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656259753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178470057 | ||||||||
| FaxNumber: | 4178470079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2002021754 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | # PENDING | 05 | MO | MEDICAID |