Provider Demographics
NPI:1285529099
Name:DALLEY, KRISTIAN
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:DALLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 E CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8639
Mailing Address - Country:US
Mailing Address - Phone:435-862-7557
Mailing Address - Fax:
Practice Address - Street 1:65 N 1150 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2062
Practice Address - Country:US
Practice Address - Phone:435-879-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9854069-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse