Provider Demographics
NPI:1003368283
Name:DELAHUNTY, MCKIE ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKIE
Middle Name:ALAN
Last Name:DELAHUNTY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E STE 10
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2580
Mailing Address - Country:US
Mailing Address - Phone:801-268-4141
Mailing Address - Fax:
Practice Address - Street 1:4000 S 700 E STE 10
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2580
Practice Address - Country:US
Practice Address - Phone:801-268-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10119894-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant