Basic Information
| Provider Information | |||||||||
| NPI: | 1396720488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C, MPAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA MEDDAC ATTN: CREDENTIALS | ||||||||
| Address2: | 650 HUEBNER ROAD | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | USA MEDDAC ATTN: CREDENTIALS | ||||||||
| Address2: | 650 HUEBNER ROAD | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 15-02292 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.