Provider Demographics
NPI:1780936351
Name:BUXTON, KAYLYNN (RN, CDE)
Entity type:Individual
Prefix:MRS
First Name:KAYLYNN
Middle Name:
Last Name:BUXTON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 E 400 N
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1954
Mailing Address - Country:US
Mailing Address - Phone:808-386-1727
Mailing Address - Fax:
Practice Address - Street 1:615 ARAPEEN DR. SUITE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-587-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361076-3102163WD0400X
HI21120062163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator