Provider Demographics
NPI:1669832853
Name:JESSOP, KAYLA (RDN, CDN, CEDS-S)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:JESSOP
Suffix:
Gender:F
Credentials:RDN, CDN, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 W 3325 N
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8632
Mailing Address - Country:US
Mailing Address - Phone:801-888-3397
Mailing Address - Fax:
Practice Address - Street 1:4578 S HIGHLAND DR STE 380
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-4204
Practice Address - Country:US
Practice Address - Phone:801-888-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008436-1133V00000X
UT86027147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered