MEDICARE: TYSON OAKEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2854334405	UT

General Provider Information

NPI Number	:	1235531500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSON OAKEY NP

Provider Business Mailing Address
First Line	:	3860 JACKSON AVE STE 7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-1979
Country	:	US
Telephone Number	:	801-664-9501
Fax Number	:	801-384-0612

Provider Business Practice Location Address
First Line	:	3860 JACKSON AVE STE 7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-1979
Country	:	US
Telephone Number	:	801-664-9501
Fax Number	:	801-384-0612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	07/10/2015

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Directions to “ TYSON OAKEY NP” Practice Location

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