Individual
KELLI A. JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2300 HOSPITAL DR, SUITE 360, BOSSIER CITY, LA 71111-2394
(318) 212-7902
(318) 212-7905
Mailing address
2300 HOSPITAL DR, SUITE 360, BOSSIER CITY, LA 71111-2394
(318) 212-7902
(318) 212-7905
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP05911
LA
Other
Enumeration date
10/21/2009
Last updated
10/27/2009
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