Provider Demographics
NPI:1508750381
Name:WOOTON, SOPHIE MCKAYE (RD)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:MCKAYE
Last Name:WOOTON
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 1:1240 E STRINGHAM AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1037
Mailing Address - Country:US
Mailing Address - Phone:830-275-9253
Mailing Address - Fax:
Practice Address - Street 1:1240 E STRINGHAM AVE APT 107
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1037
Practice Address - Country:US
Practice Address - Phone:830-275-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14189724-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered