Provider Demographics
NPI:1477026201
Name:DALEY, KERRYANN (APRN)
Entity Type:Individual
Prefix:
First Name:KERRYANN
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KERRY-ANN
Other - Middle Name:
Other - Last Name:MCCOOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 MAIN ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1568
Mailing Address - Country:US
Mailing Address - Phone:860-276-8453
Mailing Address - Fax:
Practice Address - Street 1:710 MAIN ST BLDG 1
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1568
Practice Address - Country:US
Practice Address - Phone:860-276-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11439363LF0000X
CT99969163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health