Provider Demographics
NPI:1447277462
Name:DALNESS, AIMI N (PA-C)
Entity type:Individual
Prefix:
First Name:AIMI
Middle Name:N
Last Name:DALNESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W PARKER RD STE 502
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7993
Mailing Address - Country:US
Mailing Address - Phone:972-238-0512
Mailing Address - Fax:972-378-6925
Practice Address - Street 1:6130 W PARKER RD STE 502
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7993
Practice Address - Country:US
Practice Address - Phone:972-238-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC548363A00000X, 363AM0700X
TXPA12424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0047PAMedicaid
SCAA74094639Medicare PIN
SCAA74096072Medicare PIN
SC5389435OtherFIRST HEALTH
SC548OtherSC STATE MEDICAL LICENSE
SCS864305189Medicare ID - Type UnspecifiedSC MEDICARE MB