Healthcare Provider Details

I. General information

NPI: 1588835367
Provider Name (Legal Business Name): KIM M DAVY-MCCLURE RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM M DAVY RD, CDE

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E SUITE 310
MURRAY UT
84107-8100
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4500
  • Fax: 801-314-2909
Mailing address:
  • Phone: 801-233-4400
  • Fax: 801-233-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5387258-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: