JASON KELLY BROCKWAY (NPI# 1043283823) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043283823 |
| Entity Type | Individual |
| Full Name | JASON KELLY BROCKWAY |
| Credential | MD |
| Practice Address |
1718 S Henderson Blvd Kilgore TX 75662-3566 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9039832110 |
| Mailing Telephone | 9033246450 |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-10-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | K0427 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TRICARE | 752616977017 | 01 |
| TX | 081026902 | 05 | |
| TX | AETNA | 5411635 | 01 |
| TX | SUPERIOR CHIPS | 117311 | 01 |
| TX | BCBS OF TEXAS | 87581G | 01 |
| TX | CHIPS | 117311 | 01 |
| TX | 113244103 | 05 | |
| TX | TRICARE CHAMPUS | 752616977017 | 01 |
| TX | 113244106 | 05 |
| Street Address |
1718 S HENDERSON BLVD |
| City | KILGORE |
| State | TX |
| Zip Code | 75662-3566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861484370 | Tana Sims Sandel | Physician Assistant | 1718 S Henderson Blvd, Kilgore, TX 75662-3566 | 2005-08-19 |
| 1932666302 | Caitlyn J Vanmeter | Nurse Practitioner | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2019-02-21 |
| 1104282565 | Christopher Kirk Bailey | Nurse Practitioner | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2016-01-14 |
| 1235532656 | Allyson Thompson | Nurse Practitioner | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2014-09-30 |
| 1285036582 | Sharla Shead | Nurse Practitioner | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2014-09-18 |
| 1215111273 | Kimberly Nicole Page | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2007-12-26 |
| 1962525477 | Northeast Texas Orthopaedic Spcecialists Pa | Specialist | 1718 S Henderson Blvd, Suite 4, Kilgore, TX 75662-3566 | 2007-04-09 |
| 1376593335 | Trinity Clinic | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3566 | 2006-05-11 |
| 1609840388 | Mark Douglas Miller | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3553 | 2006-02-17 |
| 1942275565 | James E Repasky | Family Medicine | 1718 S Henderson Blvd, #7, Kilgore, TX 75662-3553 | 2006-02-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346890621 | Linda Gail Watson | Technician | 190 Glendale St, Kilgore, TX 75662 | 2019-09-18 |
| 1174185151 | Jennifer Darlene Franks | Registered Nurse | 6144 Gateway Center Pmb # 320, Kilgore, TX 75662 | 2019-07-01 |
| 1215363312 | Kilgore Integrated Health Pllc | Chiropractor | 726 Us Highway 259 N, Kilgore, TX 75662 | 2013-09-20 |
| 1407172240 | Jeffrey Alan Davis | Specialist/Technologist | 300 N. Kilgore Street, Kilgore, TX 75662 | 2010-04-19 |
| 1396923777 | Rachel Thunder Rose Wyatt | Physical Therapist | 1200 Dudley Road, Kilgore, TX 75662 | 2008-02-07 |
| 1346313673 | Brookshire Grocery Company | Pharmacy | 747 Hwy 259 North, Attention Pharmacy Dept, Kilgore, TX 75662 | 2006-11-16 |
| 1417026451 | Jeffery John Pinkerton | Optometrist | 800 Highway 259 North, Kilgore, TX 75662 | 2006-11-06 |
| 1831205004 | Joseph Claude De Graffenried Jr. | Dentist | 238 Lawrence St, Kilgore, TX 75662 | 2006-08-21 |
| 1235159500 | Charles Robert Cottier | Chiropractor | 316 Henderson, Kilgome, TX 75662 | 2006-07-20 |
| 1346509494 | Kelton Hospice, Inc. | Hospice Care, Community Based | 1100 Stone Road, Suite 269, Kilgore, TX 75662 | 2012-05-10 |
| Find all providers in zip 75662 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396740064 | John K. Wolcott | Family Medicine | 5174 Fm 1252 W, Kilgore, TX 75662-1961 | 2005-06-17 |
| 1033481106 | Michael W. Mcshan, M.d., P.a. | Family Medicine | 1711 S Henderson Blvd, Suite 300, Kilgore, TX 75662-3563 | 2012-02-03 |
| 1215111273 | Kimberly Nicole Page | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3544 | 2007-12-26 |
| 1588615983 | Wayne E Fertson | Family Medicine | 2019 S Henderson Blvd, Ste 1, Kilgore, TX 75662 | 2006-05-12 |
| 1376593335 | Trinity Clinic | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3566 | 2006-05-11 |
| 1609840388 | Mark Douglas Miller | Family Medicine | 1718 S Henderson Blvd, Kilgore, TX 75662-3553 | 2006-02-17 |
| 1942275565 | James E Repasky | Family Medicine | 1718 S Henderson Blvd, #7, Kilgore, TX 75662-3553 | 2006-02-17 |
| 1760456792 | Clark Wynn Langley | Family Medicine | 1718 S Henderson Blvd, #8, Kilgore, TX 75662-3566 | 2006-02-15 |
| 1942285895 | Gary C. White | Family Medicine | 2019 S Henderson Blvd, #4, Kilgore, TX 75662-3672 | 2005-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073599 | Julie Suzanne Rodriguez | Family Medicine | 421 W Wadley Ave Ste B, Midland, TX 79705-5368 | 2020-11-06 |
| 1871194670 | Priscilla Tehrani | Family Medicine | 615 North Loop E Unit 100, Houston, TX 77022-5934 | 2020-11-06 |
| 1821699976 | Dr. G Medical Solutions | Family Medicine | 4840 W Panther Creek Dr Ste 211, The Woodlands, TX 77381-3542 | 2020-11-05 |
| 1124629522 | Jose Reynaldo Carcamo Jr. | Family Medicine | 18568 Texas 46, Suite 1001, Spring Branch, TX 78070 | 2020-11-03 |
| 1205437662 | Angela Ekern | Family Medicine | 7421 Cordoba Dr, Austin, TX 78724-6252 | 2020-11-03 |
| 1770184020 | Kara Fenceroy | Family Medicine | 5425 Rolling Meadows Dr, Fort Worth, TX 76123-2836 | 2020-11-03 |
| 1881295327 | Courtney L Buchmeier | Family Medicine | 16620 San Pedro Ave, San Antonio, TX 78232-2327 | 2020-11-02 |
| 1003416207 | Adeline Galvez | Family Medicine | 1300 W Terrell Ave Ste 270, Fort Worth, TX 76104-2820 | 2020-10-27 |
| 1710585229 | Megan Alyse Loyd | Family Medicine | 2101 Kingsley Dr Apt 3106, Pearland, TX 77584-4118 | 2020-10-16 |
| 1104424795 | Rachel Elizabeth Whitten | Family Medicine | 614 S Business Ih 35 Ste A, New Braunfels, TX 78130-4748 | 2020-10-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.