Individual
KASSIDY JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6840 GLENWOOD AVE, RALEIGH, NC 27612-7133
(866) 389-2727
Mailing address
6840 GLENWOOD AVE, RALEIGH, NC 27612-7133
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
277714
NC
363LF0000X
Family Nurse Practitioner
Primary
5012203
NC
Other
Enumeration date
09/01/2019
Last updated
09/13/2024
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