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Deactivated NPI 1023267697 Deactivated / Inactive NPI Male Practitioner

Jerry Don Wilson , PA-C

Physician Assistant • Shamrock, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jerry Wilson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 18, 2008
NPI Deactivation Date October 30, 2024
Total Practice Duration ~16 Years of Practice (2008 – 2024)

Professional Overview & Biography Verified Profile Summary

Jerry Wilson, PA-C was a registered Physician Assistant practicing in Shamrock, TX. Throughout an active medical career spanning 16 years, Jerry Wilson provided care at the practice location at 1010 S MAIN ST until profile deactivation on 2024-10-30.

Practice Location & Contact Primary Location

Practice Address

1010 S Main St

Shamrock, TX 790792820

Telephone 8062565148
Fax 8062565380
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Shamrock, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 13.9 Yrs
Regional Practice Density
1 Specialists

Practicing in Shamrock, TX (11140 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License TX PA00189

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Daissy Cadena , FNP

Nurse Practitioner - Family

NPI 1053977819

Family Nurse Practitioner

Dr. Juan Viola , MD

Emergency Medicine

NPI 1356430649

Doctor of Medicine (M.D.)

Katherine Fires , APRN, FNP-C

Nurse Practitioner - Family

NPI 1780293753

Advanced Practice Registered Nurse, Family Nurse Practitioner (Certified)

Dr. William Davis , MD

Family Medicine

NPI 1821444530

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 30, 2024

Record deactivated on October 30, 2024

NPI Profile Active September 18, 2008

NPI status registered as active in NPPES database

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Updated Practice Location September 18, 2008

Registered at 1010 S MAIN ST, SHAMROCK, TX 790792820 (Tel: 8062565148)

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Updated Business Mailing Address September 18, 2008

Registered at 1010 S MAIN ST, SHAMROCK, TX 790792820 (Tel: 8062565148)

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Provider Name / Credentials Updated September 18, 2008

Recorded as JERRY WILSON, PA-C

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 18, 2008

Physician Assistant (License #PA00189 in TX)

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Initial NPI Registration & Enumeration September 18, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1023267697
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 18, 2008
Last Update: September 18, 2008
Deactivation Date: October 30, 2024

Mailing Address

1010 S Main St

Shamrock, TX 790792820

Phone: 8062565148

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.