Provider Demographics
NPI:1114067436
Name:DAY, DAVID B (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:DAY
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 1:333 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-3000
Mailing Address - Country:US
Mailing Address - Phone:785-743-2124
Mailing Address - Fax:785-743-2265
Practice Address - Street 1:333 N 14TH ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-3000
Practice Address - Country:US
Practice Address - Phone:785-743-2124
Practice Address - Fax:785-743-2265
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS18199Medicare UPIN
KS103022Medicare ID - Type UnspecifiedPRATT MED CENTER ER