Healthcare Provider Details

I. General information

NPI: 1568287712
Provider Name (Legal Business Name): MISTY LYNNE BLISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY LYNNE WALTERS

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 NORTH MAIN STREET
NEPHI UT
84648
US

IV. Provider business mailing address

PO BOX 10
GUNNISON UT
84634-0010
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-1456
  • Fax:
Mailing address:
  • Phone: 435-283-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: