Provider Demographics
NPI:1114437183
Name:FOGGIN, JANA LYN (RD,)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LYN
Last Name:FOGGIN
Suffix:
Gender:F
Credentials:RD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:435-251-2878
Practice Address - Street 1:2891 E MALL DRIVE, STE 101
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8479
Practice Address - Country:US
Practice Address - Phone:435-688-1634
Practice Address - Fax:435-688-1635
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1088180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered