Individual
KAYLA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 CANDY PARK RD, PEMBROKE, NC 28372-9120
(910) 521-0201
Mailing address
1153 RED HILL RD, MAXTON, NC 28364-8085
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09695
NC
363AM0700X
Medical Physician Assistant
0010-09695
NC
Other
Enumeration date
01/08/2020
Last updated
04/02/2020
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