MEDICARE: JACOB M ANDREASEN 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	363AM0700X	Medical Physician Assistant	2730	NE

General Provider Information

NPI Number	:	1023763695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB M ANDREASEN PA-C

Provider Business Mailing Address
First Line	:	1714 W 56TH ST APT D110
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68845-4123
Country	:	US
Telephone Number	:	308-440-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 SARATOGA BLVD STE 200
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2999
Country	:	US
Telephone Number	:	361-993-8510
Fax Number	:	361-985-2917

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

Provider Enumeration Date	:	02/13/2022
Last Update Date	:	09/11/2025

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