Edly, Kirt Lee

Edly, Kirt Lee is an individual health care provider with primary practice located at 39000 Bob Hope Dr, Harry & Diane Rinker Building , Rancho Mirage CA 92270-3221. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Edly, Kirt Lee can be contacted via phone (760) 568-2684.

Contact Information

Primary practice address
39000 Bob Hope Dr, Harry & Diane Rinker Building Rancho Mirage CA 92270-3221
Phone: (760) 568-2684
Fax: (760) 341-5832
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA21381 California
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA21381 California

Profile Details

NPI number 1053575746
LBN Legal business name Edly, Kirt Lee
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2008
Last updated Apr 5th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053575746 NPPES
California Other PA21381 CALIFORNIA LICENSE

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