Individual
KEVIN S JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1200 ROBERTS AVE NE, COOPERSTOWN MEDICAL CENTER, COOPERSTOWN, ND 58425-7101
(701) 797-2128
Mailing address
1200 ROBERTS AVE NE, COOPERSTOWN MEDICAL CENTER, COOPERSTOWN, ND 58425-7101
(701) 797-2128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R1561072
MN
363L00000X
Nurse Practitioner
Primary
R27650
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19682
—
ND
Enumeration date
07/12/2006
Last updated
05/23/2012
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