Healthcare Provider Details

I. General information

NPI: 1144817446
Provider Name (Legal Business Name): SHYLETTERA DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 WEST 1290 NORTH
LEHI UT
84043-2327
US

IV. Provider business mailing address

641 W 1290 N
LEHI UT
84043-2327
US

V. Phone/Fax

Practice location:
  • Phone: 801-796-2678
  • Fax: 801-877-5583
Mailing address:
  • Phone: 801-796-2678
  • Fax: 801-877-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10094188-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: