Provider Demographics
NPI:1629072269
Name:WEST-LINGO, JELETA (PA)
Entity Type:Individual
Prefix:
First Name:JELETA
Middle Name:
Last Name:WEST-LINGO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBYTON
Practice Address - State:TX
Practice Address - Zip Code:79322-2143
Practice Address - Country:US
Practice Address - Phone:806-725-5844
Practice Address - Fax:806-723-7535
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01030363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N521Medicare ID - Type Unspecified
TXS57059Medicare UPIN