Healthcare Provider Details

I. General information

NPI: 1649101791
Provider Name (Legal Business Name): SHYLO VICTORIA PAYNE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3561 W 11400 S STE B
SOUTH JORDAN UT
84095-1286
US

IV. Provider business mailing address

5081 W BERRY CREEK DR
RIVERTON UT
84096-7511
US

V. Phone/Fax

Practice location:
  • Phone: 801-849-0674
  • Fax:
Mailing address:
  • Phone: 801-891-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6313755-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: