Healthcare Provider Details

I. General information

NPI: 1114507258
Provider Name (Legal Business Name): MRS. KIRSTEN DALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 E BRIARWOOD AVE STE 105
CENTENNIAL CO
80112-3925
US

IV. Provider business mailing address

13001 E 17TH PL RM E7019
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 303-632-3640
  • Fax: 303-632-3642
Mailing address:
  • Phone: 719-342-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007426
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0007426
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: