Gary Wayne Jackson, PA
Physician Assistant in Levelland, TX. Individual provider (NPI-1).
NPI number1154528263
StatusActive
Last updated in NPPESDec 1, 2008
Details
- NPI
- 1154528263
- Entity type
- Individual (NPI-1)
- Name
- Gary Wayne Jackson
- Credential
- PA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 2, 2007
- Last updated
- Dec 1, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA02551 | TX | Yes |
Practice location
1804 College AveLevelland, TX 79336-6507
Phone 806-894-3141 · Fax 806-894-7094
Mailing address
1805 S. College AveLevelland, TX 79336
Phone 806-864-3141 · Fax 806-894-7094
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