Provider Demographics
NPI:1013912609
Name:SIVER, JACALYN C (PA-C)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:C
Last Name:SIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5747
Mailing Address - Country:US
Mailing Address - Phone:361-484-6243
Mailing Address - Fax:
Practice Address - Street 1:219 OAK DR S STE A
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5675
Practice Address - Country:US
Practice Address - Phone:979-297-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD359363A00000X
TXPA05248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant