Provider Demographics
NPI:1316058902
Name:DUTTON, BELINDA W (PA-C)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:W
Last Name:DUTTON
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 1:35 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5234
Mailing Address - Country:US
Mailing Address - Phone:325-695-7246
Mailing Address - Fax:325-793-2273
Practice Address - Street 1:1758 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4611
Practice Address - Country:US
Practice Address - Phone:325-695-7246
Practice Address - Fax:325-793-2273
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01804TX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01804OtherLICENSE