Provider Demographics
NPI:1831208941
Name:DALTON, KATHLEEN M (ARNP-BC, NP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DALTON
Suffix:
Gender:F
Credentials:ARNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2411
Mailing Address - Country:US
Mailing Address - Phone:816-584-8884
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:SUITE G600
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO093617163W00000X, 363LA2200X, 364SM0705X
KS14-66922-091163W00000X
KS45666363LA2200X
KS74774364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1831208941Medicaid
KS200748900AMedicaid
KS200748900BMedicaid
KS200748900BMedicaid
KS038E179BMedicare PIN
KS110330024Medicare PIN
KS200748900AMedicaid
MO1831208941Medicaid
MO038E00016Medicare PIN