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 1:1701 N HWY 75
Mailing Address - Street 2:STE 100
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-200-1807
Mailing Address - Fax:903-222-9501
Practice Address - Street 1:1701 N HWY 75
Practice Address - Street 2:STE 100
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-200-1807
Practice Address - Fax:903-222-9501
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2024-12-19
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