Shaylee C Pettit, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

8614262-4405 Issued in UT

Practice address

5711 S 1475 E Ste 201
South Ogden, UT 84403-5185

Phone

(801) 332-9034

Fax

(678) 203-9134

NPI assigned

Apr 12, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wasatch Functional Medicine

  • Clinic/Center
  • South Ogden, UT
  • NPI 1396499414
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1215679931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5711 S 1475 E STE 201",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844035185",
            "telephone_number": "801-332-9034",
            "fax_number": "678-203-9134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5711 S 1475 E STE 201",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844035185",
            "telephone_number": "801-332-9034",
            "fax_number": "678-203-9134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "SHAYLEE",
        "middle_name": "C",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-12",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "8614262-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Care of Ogden
• Tessa Pentz, RBT
• Peoplefirst Homecare & Hospice of Utah, LLC
• Tina Perry, RBT
• Catherine Kelly Peterson, FNP-C
• Millie Pfaff, ACHMC
• Morgan Piippo
• Pinnacle Preventative Health
• Lauren Marie Pizarro, APRN, RN
• Brandy Porter, RBT

• Family Nurse Practitioner in South Ogden, UT
• Providers in South Ogden, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.