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NPI Code Detail

MEDICARE: KARY ELLEN WOODRUFF R.D., M.S., C.D.

MEDICARE: KARY ELLEN WOODRUFF R.D., M.S., C.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian7743220-4901UT

General Provider Information

NPI Number : 1407166556
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARY ELLEN WOODRUFF R.D., M.S., C.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 ROUND VALLEY DR STE 110
Second Line :
City : PARK CITY
State : UT
Zip : 84060-7552
Country : US
Telephone Number : 435-333-3535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2010
Last Update Date : 12/03/2025

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