Provider Demographics
NPI:1912215476
Name:DALEY, KYLE BRANDT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BRANDT
Last Name:DALEY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:220 W 7200 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1043
Mailing Address - Country:US
Mailing Address - Phone:801-858-3461
Mailing Address - Fax:801-955-2389
Practice Address - Street 1:461 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3302
Practice Address - Country:US
Practice Address - Phone:801-539-8617
Practice Address - Fax:801-537-7238
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2021-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT7765083-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant