Provider Demographics
NPI:1912679978
Name:DOXEY, ALLY K (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLY
Middle Name:K
Last Name:DOXEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:K
Other - Last Name:DIERYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100253
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0253
Mailing Address - Country:US
Mailing Address - Phone:017-717-7718
Mailing Address - Fax:833-643-2775
Practice Address - Street 1:1160 E 3900 S STE 5000
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1275
Practice Address - Country:US
Practice Address - Phone:801-261-7479
Practice Address - Fax:801-261-7429
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10575856-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical