Individual
DELORIS M JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2608 RING ROAD, STE B107, ELIZABETHTOWN, KY 42701
(270) 506-3741
(270) 506-3768
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4607
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3004861
KY
363L00000X
Nurse Practitioner
4861P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11716456
CAQH
—
05
—
7100144180
—
KY
Enumeration date
02/05/2007
Last updated
08/25/2023
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