Individual
CARLEY A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2300 KATI CT STE A, SHELTON, WA 98584-1926
(360) 426-0955
Mailing address
PO BOX 1668, SHELTON, WA 98584-5001
(360) 426-0955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002718
VA
Other
Enumeration date
02/06/2008
Last updated
02/04/2021
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