Individual
JACOB LOUIS MUCKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP BC
Contact information
Practice address
1723 BROADWAY ST, SUITE 410, CAPE GIRARDEAU, MO 63701-4566
(573) 339-1957
(573) 339-9709
Mailing address
1723 BROADWAY ST STE 410, CAPE GIRARDEAU, MO 63701-4556
(573) 339-1957
(573) 339-9709
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2012027450
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012027450
MEDICAL LICENSE
MO
Enumeration date
08/07/2012
Last updated
01/22/2026
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