Provider Demographics
NPI:1396720488
Name:DAY, CHARLES DAVID (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DAVID
Last Name:DAY
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA MEDDAC ATTN: CREDENTIALS
Mailing Address - Street 2:650 HUEBNER ROAD
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-239-7151
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC ATTN: CREDENTIALS
Practice Address - Street 2:650 HUEBNER ROAD
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-239-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KS15-02292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN