Provider Demographics
NPI:1851638126
Name:KRECK, JAKE H (PA-C)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:H
Last Name:KRECK
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:4031 W PLANO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5619
Mailing Address - Country:US
Mailing Address - Phone:972-985-1072
Mailing Address - Fax:972-596-9382
Practice Address - Street 1:1367 DOMINION PLZ
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1013
Practice Address - Country:US
Practice Address - Phone:903-534-6200
Practice Address - Fax:903-939-0755
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2023-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical