Provider Demographics
NPI:1851627640
Name:MCPECK, JENNIKA LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIKA
Middle Name:LYN
Last Name:MCPECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIKA
Other - Middle Name:LYN
Other - Last Name:SCADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:745 S 2000 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9621
Mailing Address - Country:US
Mailing Address - Phone:801-525-2400
Mailing Address - Fax:
Practice Address - Street 1:745 S 2000 W
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9621
Practice Address - Country:US
Practice Address - Phone:801-525-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5545531-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant