Provider Demographics
NPI:1407542418
Name:JENSEN, WYLEE KYLE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:WYLEE
Middle Name:KYLE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W 400 S
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-6702
Mailing Address - Country:US
Mailing Address - Phone:435-881-0166
Mailing Address - Fax:
Practice Address - Street 1:190 S HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9512
Practice Address - Country:US
Practice Address - Phone:435-755-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8336724-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily