Provider Demographics
NPI:1306965546
Name:WILLCOX, JENNIFER LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WILLCOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 16TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5226
Mailing Address - Country:US
Mailing Address - Phone:206-326-3000
Mailing Address - Fax:
Practice Address - Street 1:201 16TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5226
Practice Address - Country:US
Practice Address - Phone:206-326-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0178761OtherL&I
G8858574OtherMEDICARE PTAN
G8858575OtherMEDICARE PTAN
1035425OtherNCCPA CERTIFICATE NUMBER
WAG8858577OtherMEDICARE PTAN
G8858578OtherMEDICARE PTAN
G8858576OtherMEDICARE PTAN
WAG8872586OtherMEDICARE PTAN
WA8879273Medicaid
WA8879273Medicaid
0178761OtherL&I
G8858575OtherMEDICARE PTAN