Healthcare Provider Details

I. General information

NPI: 1316641905
Provider Name (Legal Business Name): KORTNEY DALY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 N 92ND ST STE 225
SCOTTSDALE AZ
85258-4536
US

IV. Provider business mailing address

PO BOX 73334
PHOENIX AZ
85050-1039
US

V. Phone/Fax

Practice location:
  • Phone: 480-697-4824
  • Fax: 480-697-4825
Mailing address:
  • Phone: 760-310-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10278
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: