Individual
JAMIE SHARI LANDRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2604 SAINT MICHAEL DR STE 425, TEXARKANA, TX 75503-2378
(903) 614-5600
(903) 614-5630
Mailing address
2900 SAINT MICHAEL DR STE 401, TEXARKANA, TX 75503-5211
(903) 614-5393
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-336
AR
363A00000X
Physician Assistant
Primary
PA06337
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1F4890
MEDICARE
TX
05
—
200263770A
—
OK
01
—
P02599453
RR MCR
TX
01
—
PA-336
LICENSE #
AR
01
—
PA06337
STATE LICENSE
TX
Enumeration date
04/16/2008
Last updated
05/05/2025
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