Healthcare Provider Details

I. General information

NPI: 1356558407
Provider Name (Legal Business Name): AMY K WIGHT RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 UNIVERSITY PARK BLVD
LAYTON UT
84041-1611
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-6200
  • Fax: 801-779-6203
Mailing address:
  • Phone:
  • Fax: 801-387-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number378500-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: