Provider Demographics
NPI:1528801834
Name:OBLAD, KYENA MARAY (APRN)
Entity type:Individual
Prefix:
First Name:KYENA
Middle Name:MARAY
Last Name:OBLAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MIDVILLAGE BLVD APT 411
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1377
Mailing Address - Country:US
Mailing Address - Phone:801-347-6457
Mailing Address - Fax:
Practice Address - Street 1:152 E MIDVILLAGE BLVD APT 411
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1377
Practice Address - Country:US
Practice Address - Phone:801-347-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11765853-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health