Healthcare Provider Details

I. General information

NPI: 1902534522
Provider Name (Legal Business Name): ASHLY JANE PECK PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W REUNION AVE STE 5A
SOUTH JORDAN UT
84095-4620
US

IV. Provider business mailing address

1680 W REUNION AVE STE 5A
SOUTH JORDAN UT
84095-4620
US

V. Phone/Fax

Practice location:
  • Phone: 385-361-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12929506-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: