Provider Demographics
NPI:1508419615
Name:PETTIT, DEVRIE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:DEVRIE
Middle Name:
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 W BETHPAGE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-4168
Mailing Address - Country:US
Mailing Address - Phone:801-455-5546
Mailing Address - Fax:
Practice Address - Street 1:3906 W BETHPAGE CT
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-4168
Practice Address - Country:US
Practice Address - Phone:801-455-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71664924901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered