Provider Demographics
NPI:1477973733
Name:DALY, KELLI F (ANP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:F
Last Name:DALY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-928-2900
Mailing Address - Fax:952-928-2944
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 177398-3363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology