Basic Information
| Provider Information | |||||||||
| NPI: | 1912215476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALEY | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | BRANDT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W 7200 S | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840471043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018583461 | ||||||||
| FaxNumber: | 8019552389 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 S 400 E | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841113302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015398617 | ||||||||
| FaxNumber: | 8015377238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2010 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 7765083-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.