Healthcare Provider Details

I. General information

NPI: 1740022508
Provider Name (Legal Business Name): TALLYA LLEWELYN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

IV. Provider business mailing address

2295 S FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-3021
  • Fax: 801-485-6339
Mailing address:
  • Phone: 801-486-3021
  • Fax: 801-485-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11860219-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11860219-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: