Provider Demographics
NPI:1659919702
Name:WERT, JENIECE KAYLA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENIECE
Middle Name:KAYLA
Last Name:WERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENIECE
Other - Middle Name:KAYLA
Other - Last Name:SALNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 WESTWAY AVE STE C&D
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 WESTWAY AVE
Practice Address - Street 2:STE C & D
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-983-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1173007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program