MEDICARE: MADISON BARNEY RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	12118126-4901	UT

General Provider Information

NPI Number	:	1427916618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON BARNEY RD

Provider Business Mailing Address
First Line	:	4535 HAVEN CREEK RD UNIT C
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6954
Country	:	US
Telephone Number	:	435-512-7990
Fax Number	:	435-512-7990

Provider Business Practice Location Address
First Line	:	4535 HAVEN CREEK RD UNIT C
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6954
Country	:	US
Telephone Number	:	435-512-7990
Fax Number	:	435-512-7990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ MADISON BARNEY RD” Practice Location

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