MEDICARE: MRS. KELZIE DEVITT LAYNE

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	13054790-4901	UT

General Provider Information

NPI Number	:	1700609559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELZIE DEVITT LAYNE

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:	801-387-2800
Fax Number	:	801-387-3420

Provider Business Practice Location Address
First Line	:	4401 HARRISON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-3195
Country	:	US
Telephone Number	:	801-906-2720
Fax Number	:

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

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	01/06/2026

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