Provider Demographics
NPI:1720314289
Name:DALEY, KATHERINE E (PA)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:E
Last Name:DALEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1918 RANDOLPH ROAD
Mailing Address - Street 2:STE. 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28201
Mailing Address - Country:US
Mailing Address - Phone:704-375-6766
Mailing Address - Fax:704-332-6552
Practice Address - Street 1:1918 RANDOLPH ROAD
Practice Address - Street 2:STE. 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28201
Practice Address - Country:US
Practice Address - Phone:704-375-6766
Practice Address - Fax:704-332-6552
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02001363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical