MEDICARE: JACLYN K SWICK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1023332699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN K SWICK PA-C

Provider Business Mailing Address
First Line	:	107 STAUNTON DR
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-5604
Country	:	US
Telephone Number	:	304-269-2022
Fax Number	:	304-269-2037

Provider Business Practice Location Address
First Line	:	107 STAUNTON DR
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-5604
Country	:	US
Telephone Number	:	304-269-2022
Fax Number	:	304-269-2037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	08/31/2022

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Directions to “ JACLYN K SWICK PA-C” Practice Location

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