Provider Demographics
NPI:1407166556
Name:WOODRUFF, KARY ELLEN (RD, MS, CD)
Entity Type:Individual
Prefix:
First Name:KARY
Middle Name:ELLEN
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RD, MS, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6121
Mailing Address - Country:US
Mailing Address - Phone:801-314-4038
Mailing Address - Fax:
Practice Address - Street 1:5848 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6121
Practice Address - Country:US
Practice Address - Phone:801-314-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7743220-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered