Healthcare Provider Details

I. General information

NPI: 1104732528
Provider Name (Legal Business Name): JENNA LEIGH WAKEFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WATER ST
ORBISONIA PA
17243-9432
US

IV. Provider business mailing address

310 30TH ST
HUNTINGDON PA
16652-2834
US

V. Phone/Fax

Practice location:
  • Phone: 814-447-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA068103
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: