Individual
JACOB KELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-5220
(903) 826-3439
Mailing address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-5220
(903) 826-3439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP126076
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP126076
TX
Other
Enumeration date
10/17/2014
Last updated
08/02/2022
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