Provider Demographics
NPI:1083941918
Name:MCCRACKEN, JENNA SIGMON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:SIGMON
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MERCY CT
Mailing Address - Street 2:P.O. BOX 908
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1331
Mailing Address - Country:US
Mailing Address - Phone:606-723-5142
Mailing Address - Fax:606-723-3798
Practice Address - Street 1:62 MERCY CT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1331
Practice Address - Country:US
Practice Address - Phone:606-723-5142
Practice Address - Fax:606-723-3798
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1222363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical