Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Garry Wayne Wickliffe Jr., LSA, CST

Individual provider Surgical Assistant · NPI 1336724236

Garry Wayne Wickliffe Jr., LSA, CST is a Surgical Assistant in Tyler, Texas. Licensed in Texas. Registered with an NPI since 2021.

Licensed in
TX
In the registry since
2021
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Practice location Address checks out

704 S Fleishel Ave
Tyler, TX 75701-2014
Phone: (903) 646-5350
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Assistant (primary) Taxonomy 246ZC0007X · Licence SA00957 (TX)

Record details

NPI number1336724236
Entity typeIndividual (Type 1)
GenderMale
Credentials LSA , CST
Sole proprietorNo
NPI enumeratedMarch 11, 2021
Last updated in NPPESMarch 31, 2024
Certification dateMarch 31, 2024

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