Jackson, Gary L

Jackson, Gary L is an individual health care provider with primary practice located at 4100 Summerhill Rd , Texarkana TX 75503-2732. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Jackson, Gary L can be contacted via phone (903) 735-9802.

Contact Information

Primary practice address
4100 Summerhill Rd Texarkana TX 75503-2732
Phone: (903) 735-9802
Fax: (903) 735-9806
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 231425 Texas

Profile Details

NPI number 1700884947
LBN Legal business name Jackson, Gary L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Jul 26th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700884947 NPPES
Texas Other 83137C BLUE CROSS
Texas Other 84320 BLUE CROSS
Texas MEDICAID 002851601 BLUE CROSS
Texas MEDICAID 117307701 BLUE CROSS

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