Provider Demographics
NPI:1235531500
Name:OAKEY, TYSON (NP)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:OAKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 JACKSON AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1979
Mailing Address - Country:US
Mailing Address - Phone:801-664-9501
Mailing Address - Fax:801-384-0612
Practice Address - Street 1:3860 JACKSON AVE STE 7
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1979
Practice Address - Country:US
Practice Address - Phone:801-664-9501
Practice Address - Fax:801-384-0612
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2854334405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily