Healthcare Provider Details

I. General information

NPI: 1255191672
Provider Name (Legal Business Name): VITALITY HEALTH OF UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
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:
Mailing address:
  • Phone: 801-796-2678
  • Fax: 801-877-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY HALE-BYINGTON
Title or Position: AUTHORIZED OFFICIAL
Credential: NP
Phone: 801-796-2678