Healthcare Provider Details

I. General information

NPI: 1083286140
Provider Name (Legal Business Name): LEXIE JO CALLOWAY JEX PA-C, RDN, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N 700 W STE 250
LAYTON UT
84041-5723
US

IV. Provider business mailing address

1378 E 6000 S
SOUTH OGDEN UT
84405-7147
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number12382182-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: