MEDICARE: SHYLO VICTORIA PAYNE FNP-C

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	363LF0000X	Family Nurse Practitioner	6313755-4405	UT

General Provider Information

NPI Number	:	1649101791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLO VICTORIA PAYNE FNP-C

Provider Business Mailing Address
First Line	:	5081 W BERRY CREEK DR
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84096-7511
Country	:	US
Telephone Number	:	801-891-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3561 W 11400 S STE B
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-1286
Country	:	US
Telephone Number	:	801-849-0674
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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