Provider Demographics
NPI:1194239053
Name:BLEAK, AMY JEAN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:BLEAK
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 W MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2265
Mailing Address - Country:US
Mailing Address - Phone:435-592-4307
Mailing Address - Fax:
Practice Address - Street 1:440 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-865-1520
Practice Address - Fax:435-867-2658
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345563-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily