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General NPI Number Information
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NPI Number | 1194239053
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Entity Type | Individual
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Provider Name | AMY JEAN BLEAK APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 440 N PAIUTE DR
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City | CEDAR CITY
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State | UT
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Zip | 84721-6181
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Country | US
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Telephone | 435-865-1520
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Fax | 435-867-2658
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Provider Business Mailing Address
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Address Line | 2484 W MEADOW ST
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City | CEDAR CITY
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State | UT
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Zip | 84720-2265
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Country | US
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Telephone | 435-592-4307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345563-4405
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License Number State | UT
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