Provider Demographics
NPI:1114507258
Name:DALY, KIRSTEN
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH PL RM E7019
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2570
Mailing Address - Country:US
Mailing Address - Phone:719-342-3895
Mailing Address - Fax:
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3925
Practice Address - Country:US
Practice Address - Phone:303-632-3640
Practice Address - Fax:303-632-3642
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0007426363A00000X
CO0007426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty