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General NPI Number Information
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NPI Number | 1457900888
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Entity Type | Individual
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Provider Name | SCOTT PECKENPAUGH PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 2200 NW MYHRE RD
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City | SILVERDALE
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State | WA
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Zip | 98383-7681
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Country | US
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Telephone | 360-744-4989
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Fax |
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Provider Business Mailing Address
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Address Line | 3082 SE GROVEWOOD ST
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City | PORT ORCHARD
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State | WA
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Zip | 98367-9591
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Country | US
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Telephone | 360-509-3298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA61130139
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License Number State | WA
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