=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871457861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAYTON BETHEA RN,BSN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2025
-----------------------------------------------------
Last Update Date | 12/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4248 W 275 N
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84720-8568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-459-3549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4248 W 275 N
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84720-8568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-459-3549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 13395986-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------