KIRT LEE EDLY (NPI# 1053575746) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053575746 |
| Entity Type | Individual |
| Full Name | KIRT LEE EDLY |
| Credential | D.C., P.A. |
| Practice Address |
39000 Bob Hope Dr Harry & Diane Rinker Building Rancho Mirage CA 92270-3221 |
| Mailing Address |
Po Box 1810 Rancho Mirage CA 92270-1059 |
| Practice Telephone | 7605682684 |
| Practice Fax Number | 7698372202 |
| Mailing Telephone | 7607661250 |
| Mailing Fax Number | 7608372202 |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2011-01-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA21381 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA21381 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085003072 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CALIFORNIA LICENSE | PA21381 | 01 |
| Street Address |
39000 BOB HOPE DR HARRY & DIANE RINKER BUILDING |
| City | RANCHO MIRAGE |
| State | CA |
| Zip Code | 92270-3221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427053206 | Carol A Marietta | Nurse Practitioner | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2005-06-17 |
| 1770193021 | Corinne Estelle Worland | Dietitian, Registered | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-08-02 |
| 1134744626 | Borna Vajdi | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-06-10 |
| 1902429079 | Ana Carolina Anguiano Jaimes | Nurse Practitioner | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-05-24 |
| 1437779543 | Sanjai Krishna Jothikumar | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-04-18 |
| 1659991966 | Raphi Hambartzhumian | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-04-17 |
| 1669091252 | Catherine Goff | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-04-13 |
| 1659990471 | Zariah Chappell | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-04-11 |
| 1043839186 | Brandyce Elia | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Achs-gme Office Suite 201, Rancho Mirage, CA 92270-3221 | 2020-04-09 |
| 1659990604 | Dona Therese El-khoury | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Dr, Rancho Mirage, CA 92270-3221 | 2020-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235757824 | Monsetrrat Martinez | Behavioral Analyst | 69930 Ca-111, Ste 118, Rancho Mirage, CA 92270 | 2020-07-09 |
| 1306475785 | Christine Palmares | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Drive, Achs-gme Office, Rancho Mirage, CA 92270 | 2020-04-07 |
| 1821627449 | Dino Mellone | Student in an Organized Health Care Education/Training Program | 39000 Bob Hope Drive, Achs-gme Office Ste. 201, Rancho Mirage, CA 92270 | 2020-04-06 |
| 1356970164 | Chris Kim | Student in an Organized Health Care Education/Training Program | Eisenhower Health Emergency Medicine Residency, 39000 Bob Hope Dr., Achs-gme Office, Rancho Mirage, CA 92270 | 2020-04-03 |
| 1609434075 | Junko Ohara | Student in an Organized Health Care Education/Training Program | Eisenhower Health Internal Medicine Residency, 39000 Bob Hope Drive, Achs-gme Office, Rancho Mirage, CA 92270 | 2019-05-31 |
| 1245791896 | Iman Rasheed | Student in an Organized Health Care Education/Training Program | 3900 Bob Hope Drive, Achs-gme Office, Rancho Mirage, CA 92270 | 2019-03-27 |
| 1073086583 | Robert B Greene | Internal Medicine | 8 Moon Lake Drive, Rancho Mirage, CA 92270 | 2019-01-08 |
| 1356818884 | Kade Bartschi | Dentist | 1591 Griffin Rd, 29 Palms, CA 92270 | 2018-11-02 |
| 1841775392 | Rose Pharmacy Rm LLC | Pharmacy | 35400 Bob Hope Drive, Suite #207, Rancho Mirage, CA 92270 | 2018-10-01 |
| 1235615956 | Trang Huyen Nguyen | Dentist | 71-817 Hwy 111 Suite A, Rancho Mirage, CA 92270 | 2018-07-16 |
| Find all providers in zip 92270 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801088372 | Sherry Lee Wilson | Physician Assistant | 40075 Bob Hope Dr Ste A, Rancho Mirage, CA 92270-3945 | 2007-08-17 |
| 1336240316 | Jeffrey Dean Kohfeld | Physician Assistant | 72780 Country Club Dr., Rancho Mirage, CA 92270 | 2006-09-25 |
| 1225064983 | April Susan Ethridge | Physician Assistant | 72785 Frank Sinatra Dr Ste 100, Rancho Mirage, CA 92270-3207 | 2006-06-24 |
| 1295774826 | Matthew J. Smith | Physician Assistant | 22032 Frank Sinatra Drive, Suite 100, Rancho Mirage, CA 92270 | 2006-06-06 |
| 1932585361 | Kevin Eugene Hearn | Physician Assistant | 39000 Bob Hope Dr, Harry & Diane Rinker Building, Rancho Mirage, CA 92270-3221 | 2015-08-07 |
| 1508256751 | Jim Shamblin Rosell | Physician Assistant | 39000 Bob Hope Dr, Harry & Diane Rinker Building, Rancho Mirage, CA 92270-3221 | 2015-01-27 |
| 1558613935 | Brendan Cormac Murphy | Physician Assistant | 39000 Bob Hope Dr, Harry & Diane Rinker Building, Rancho Mirage, CA 92270-3221 | 2012-10-09 |
| 1184988800 | Vanessa Anntoinette Cascio | Physician Assistant | 39000 Bob Hope Dr, Harry & Diane Rinker Building, Rancho Mirage, CA 92270-3221 | 2012-06-27 |
| 1841561487 | Jennifer Ann Henderson | Physician Assistant | 39000 Bob Hope Dr, Hal B Wallis Bldg, Rancho Mirage, CA 92270-3221 | 2012-01-12 |
| 1881920007 | Juanita A Moore | Physician Assistant | 39000 Bob Hope Dr, Emergency Department, Rancho Mirage, CA 92270-3221 | 2009-10-22 |
| Find all providers in RANCHO MIRAGE | ||||
| City | RANCHO MIRAGE |
| Zip Code | 92270 |
Please comment or provide details below to improve the information on KIRT LEE EDLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.