Healthcare Provider Details

I. General information

NPI: 1306132592
Provider Name (Legal Business Name): CHRISTINE A. JACOBS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE A. WINTER DO

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number1003
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1003
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: