NPIMap

Individual provider Active NPI

Kelly Marie Dalton, AGACNP-BC

  • Gerontology Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1770119372
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
2020009164 Issued in MO
Practice address
1235 E Cherokee St
Springfield, MO 65804-2203
Phone
(417) 820-3911
NPI assigned
Mar 16, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 2020009164 MO Primary

Addresses

Primary practice location

1235 E Cherokee St
Springfield, MO 65804-2203

Mailing address

1235 E Cherokee St
Springfield, MO 65804-2203
Phone (417) 820-3911

Other identifiers 1

IdentifierTypeStateIssuer
420081844MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200328000059 MO Practitioner - Nurse Practitioner 1456780386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

448 State Hwy 248
Suite 180
Branson, MO 65616-3725
Phone (417) 820-3911

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Jan 2, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 2, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 2, 2023 Accepting new patients

Locations

448 State Highway 248
Ste 180
Branson, MO 65616
Phone (417) 820-2064

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

3801 S National Ave
Springfield, MO 65807
Phone (417) 269-4056

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

1235 E Cherokee St
Ste 2D
Springfield, MO 65804

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1770119372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALTON",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-16",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2020009164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420081844",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.