Provider Demographics
NPI:1750914446
Name:LAYTON, NICK BLAINE (PA)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:BLAINE
Last Name:LAYTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6654 S STONE MILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5097 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5725
Practice Address - Country:US
Practice Address - Phone:801-851-5554
Practice Address - Fax:833-464-2575
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT11057552-1206207QA0505X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine