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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JERRICA PARK PA-C
NPI 1245821669
Community/Behavioral Health in Flagstaff, AZ

Active since January 28, 2021PECOS Enrolled
1120 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001(928) 522-1300(928) 522-1301 Get Directions Write a Review

NPPES record last updated: June 17, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 3, 2025, Dec 9, 2024, Feb 6, 2023 and 2 more (5 updates tracked since 2021).

About Jerrica Park Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRICA PARK PA-C (NPI 1245821669) is an individual community/behavioral health provider in Flagstaff, Arizona and active in the NPI registry since January 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Oxnard.

NPPES Registry Identity

NPI1245821669
Entity TypeIndividualFemale
Primary Taxonomy251S00000X
Provider Legal NameJERRICA PARKCredential: PA-C
Location Address1120 W UNIVERSITY AVE STE 101Flagstaff, AZ 86001-2851
Mailing AddressPo Box 3630Flagstaff, AZ 86003-3630 · (928) 522-9879
Phone(928) 522-1300
Fax(928) 522-1301
Sole ProprietorYes
Enumeration DateJanuary 28, 2021
Last NPPES UpdateJune 17, 20265 updates tracked since enumeration
NPPES CertifiedJune 17, 2026
✔ NPI 1245821669 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Also ListedPhysician AssistantTaxonomy 363A00000X · License 9452 (AZ), 65593 (CA)
1120 W UNIVERSITY AVE STE 101, Flagstaff, AZ 86001
Open in Google Maps ↗

Secondary Practice Location 1

Location 12100 Statham BlvdOxnard, CA 93033 · Phone (805) 920-7021 · Fax (805) 920-7045

Other Identifiers 1

Medicaid157725AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jerrica Park Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JENNIFER EKDAHL CORTES M.D.
Internal Medicine
1120 W UNIVERSITY AVE STE 101
FLAGSTAFF, AZ 86001
Coconino County (928) 522-1300
JANE ZUCCOLILLO
Physician Assistant
1120 W UNIVERSITY AVE STE 101
FLAGSTAFF, AZ 86001
Coconino County (928) 522-1300
EMILY R LIEDER DO
Family Medicine
1120 W UNIVERSITY AVE STE 101
FLAGSTAFF, AZ 86001
Coconino County (928) 522-1300
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER INC
Clinic/Center (Federally Qualified Health Center (FQHC))
1120 W UNIVERSITY AVE STE 101
FLAGSTAFF, AZ 86001
Coconino County (520) 670-3909
ALEXIS BERGER LAC
Counselor (Mental Health)
1120 W UNIVERSITY AVE STE 101
FLAGSTAFF, AZ 86001
Coconino County (520) 640-7189

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerrica Park's NPI number?

The NPI number for Jerrica Park is 1245821669. It was assigned to this individual provider in the NPPES registry on January 28, 2021.

Where is Jerrica Park located?

Jerrica Park practices at 1120 W University Ave Ste 101, Flagstaff, AZ 86001. The listed phone number is (928) 522-1300.

What is Jerrica Park's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Jerrica Park enrolled in Medicare?

Yes. Jerrica Park is registered in the Medicare PECOS enrollment system.

What insurance does Jerrica Park accept?

Health plans from Blue Cross Blue Shield of Arizona list Jerrica Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jerrica Park was last updated on June 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 55 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.