MEDICARE: JACOB ANDREW WHITE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013881176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ANDREW WHITE PA-C

Provider Business Mailing Address
First Line	:	5502 PRAIRIE CREEK DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-8463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 HOSPITAL DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3050
Country	:	US
Telephone Number	:	660-888-2238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	12/16/2025

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Directions to “ JACOB ANDREW WHITE PA-C” Practice Location

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