Individual
GARY L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4100 SUMMERHILL RD, TEXARKANA, TX 75503-2732
(903) 735-9802
(903) 735-9806
Mailing address
4100 SUMMERHILL RD, TEXARKANA, TX 75503-2732
(903) 735-9802
(903) 735-9806
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
231425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002851601
—
TX
05
—
117307701
—
AR
01
—
83137C
BLUE CROSS
TX
01
—
84320
BLUE CROSS
AR
Enumeration date
07/12/2005
Last updated
07/26/2014
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