Healthcare Provider Details

I. General information

NPI: 1598689499
Provider Name (Legal Business Name): MAYCIE WEBB PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYCIE LOLLAR

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MARVIN HANCOCK DR
JASPER TX
75951-4934
US

IV. Provider business mailing address

170 WESTVIEW DR
LUFKIN TX
75904-7591
US

V. Phone/Fax

Practice location:
  • Phone: 409-489-9322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: