Provider Demographics
NPI:1073296570
Name:CHEAL, JACKSON (PA-S)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:CHEAL
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 MARRCREST W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3823
Mailing Address - Country:US
Mailing Address - Phone:801-310-8039
Mailing Address - Fax:
Practice Address - Street 1:951 S GENEVA RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5857
Practice Address - Country:US
Practice Address - Phone:801-863-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program