Provider Demographics
NPI:1578805396
Name:SACKETT, GARY DALE II (NP-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DALE
Last Name:SACKETT
Suffix:II
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:DALE
Other - Last Name:SACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1806 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4206
Mailing Address - Country:US
Mailing Address - Phone:806-288-7891
Mailing Address - Fax:806-288-7920
Practice Address - Street 1:1806 QUINCY ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-4206
Practice Address - Country:US
Practice Address - Phone:806-288-7891
Practice Address - Fax:806-288-7920
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578805396OtherFAMILY MEDICINE