Healthcare Provider Details

I. General information

NPI: 1770433526
Provider Name (Legal Business Name): LUKE KONNOR JACOBS PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

IV. Provider business mailing address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7000
  • Fax:
Mailing address:
  • Phone: 606-487-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: