Provider Demographics
NPI:1851145742
Name:PECARINA, JESSICA LEEANN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEEANN
Last Name:PECARINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4711
Mailing Address - Country:US
Mailing Address - Phone:307-856-8090
Mailing Address - Fax:
Practice Address - Street 1:450 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4711
Practice Address - Country:US
Practice Address - Phone:307-856-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY161175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist