Most Relevant Information
Provider Data
| NPI Number: | 1003526468 |
| Provider Name: | BLAKE HENRY MILES FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 5808074-4405 |
Most Important Dates
| Enumeration Date: | 11/28/2022 |
| Last Updated: | 11/28/2022 |
Provider Practice Location
977 S VIA LA COSTA WAY
KAYSVILLE
UT
840372839
Practice Location Phone/Fax
| Phone: | 8015896988 |
| Fax: |
Provider Mailing Location
977 S VIA LA COSTA WAY
KAYSVILLE
UT
840372839
Provider Mailing Phone/Fax
| Phone: | 8015896988 |
| Fax: |