Kayla Blickensderfer

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1052 E Barbara PL
Salt Lake City, UT 84102-3111

Phone

(605) 786-4904

NPI assigned

Jun 2, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1124767512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 E BARBARA PL",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023111",
            "telephone_number": "605-786-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 E BARBARA PL",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023111",
            "telephone_number": "605-786-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICKENSDERFER",
        "first_name": "KAYLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Dawn Bledsoe, M.D.
• Terrell K. Blei, MD
• Julie Bleiweiss
• Megan Lin Bletzacker, PNP, RN
• Steven Benjamin Bleyl, MD
• Stella Blight, A.P.R.N.
• Lizabeth Anne Blike, MS, RDN, CD
• Andrew James Bliss, D.D.S.
• Catherine Bliss, MS
• Delainee Bliss

• All providers in Salt Lake City, UT
• Student in an Organized Health Care Education/Training Program in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.