MEDICARE: JESSICA WOEPPEL 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	363AS0400X	Surgical Physician Assistant	13487669-1206	UT
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1922874981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WOEPPEL PA-C

Provider Business Mailing Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4252 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2670
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	02/19/2025

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