Individual
JERRICA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1120 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001-2851
(928) 522-1300
(928) 522-1301
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9879
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363A00000X
Physician Assistant
9452
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157725
—
AZ
Enumeration date
01/28/2021
Last updated
04/03/2025
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