Jerry Wayne Leisure, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00032 Issued in TX

Practice address

108 6TH St
Winfield, TX 75493

Phone

(903) 524-4700

Fax

(903) 524-4900

NPI assigned

May 14, 2007

Last updated

Jul 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1356556906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545327",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 6TH ST",
            "city": "WINFIELD",
            "state": "TX",
            "postal_code": "75493",
            "telephone_number": "903-524-4700",
            "fax_number": "903-524-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEISURE",
        "first_name": "JERRY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.