Individual
JACOB ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27427 E 109TH ST S, COWETA, OK 74429-3442
(918) 617-1978
Mailing address
27427 E 109TH ST S, COWETA, OK 74429-3442
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
225438
OK
Other
Enumeration date
08/08/2025
Last updated
12/11/2025
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