Healthcare Provider Details

I. General information

NPI: 1336857655
Provider Name (Legal Business Name): KASE ALLEN JACOBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALNUT ST
DAWSON MN
56232-2333
US

IV. Provider business mailing address

1282 WALNUT ST
DAWSON MN
56232-2333
US

V. Phone/Fax

Practice location:
  • Phone: 320-769-4323
  • Fax:
Mailing address:
  • Phone: 320-769-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9955
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: