Healthcare Provider Details

I. General information

NPI: 1700609559
Provider Name (Legal Business Name): MRS. KELZIE DEVITT LAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403-3195
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-906-2720
  • Fax:
Mailing address:
  • Phone: 801-387-2800
  • Fax: 801-387-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number13054790-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: