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 1:2218 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:TEKONSHA
Mailing Address - State:MI
Mailing Address - Zip Code:49092-9261
Mailing Address - Country:US
Mailing Address - Phone:517-767-4038
Mailing Address - Fax:
Practice Address - Street 1:2218 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:TEKONSHA
Practice Address - State:MI
Practice Address - Zip Code:49092-9261
Practice Address - Country:US
Practice Address - Phone:517-767-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2025-01-08
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