Provider Demographics
NPI:1760667711
Name:GAMBLE, JESSICA LEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEANNE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 MEDICAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6372
Mailing Address - Country:US
Mailing Address - Phone:903-957-0470
Mailing Address - Fax:903-957-0369
Practice Address - Street 1:204 MEDICAL DR STE 140
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6372
Practice Address - Country:US
Practice Address - Phone:903-957-0470
Practice Address - Fax:903-957-0369
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05463OtherLICENSE