Individual
JEANETTE MARIE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
901 WALLACE AVE, LEITCHFIELD, KY 42754
(270) 259-5641
(270) 259-5309
Mailing address
901 WALLACE AVE, LEITCHFIELD, KY 42754-1417
(270) 259-5641
(270) 259-5309
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3012495
KY
363L00000X
Nurse Practitioner
3012495
KY
363LP0200X
Pediatric Nurse Practitioner
3012495
KY
Other
Enumeration date
08/10/2018
Last updated
05/01/2019
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