Healthcare Provider Details

I. General information

NPI: 1851094080
Provider Name (Legal Business Name): STELLA O OBAH DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S 8TH ST
YAKIMA WA
98901-3020
US

IV. Provider business mailing address

149 EASTFORK CIR
FARMINGTON UT
84025-2672
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-4143
  • Fax:
Mailing address:
  • Phone: 385-206-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10501653-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10501653-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10501653-4405
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70026941
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: