Individual
LACEY KRISTINE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11601 S. WESTERN AVE, OKLAHOMA CITY, OK 73170-5823
(405) 512-6950
Mailing address
524 SW 124TH PL, OKLAHOMA CITY, OK 73170-6039
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
APPA2099
OK
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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