Individual
KENT BLAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1675 N FREEDOM BLVD, BLDG 3, PROVO, UT 84604-2540
(801) 377-8000
(801) 377-8001
Mailing address
1675 N FREEDOM BLVD, BLDG 3, PROVO, UT 84604-2540
(801) 377-8000
(801) 377-8001
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
217117-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D2731
—
UT
Enumeration date
11/09/2006
Last updated
10/19/2011
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