Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jackie Ray Jr., LSA

Individual provider Surgical Assistant · NPI 1962866152

Mr. Jackie Ray Jr., LSA is a Surgical Assistant in Wylie, Texas. Practices as a sole proprietor. Licensed in Texas.

Licensed in
TX
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

2007 Megan Ct
Wylie, TX 75098
Phone: (469) 658-6589
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence SA00672 (TX)
Surgical Assistant Taxonomy 246ZC0007X

Record details

NPI number1962866152
Entity typeIndividual (Type 1)
GenderMale
Credentials LSA
Sole proprietorYes
NPI enumeratedApril 13, 2016
Last updated in NPPESAugust 2, 2018

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