Healthcare Provider Details

I. General information

NPI: 1871407957
Provider Name (Legal Business Name): JACOB NUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E MOUNT VERNON BLVD
MOUNT VERNON MO
65712-9100
US

IV. Provider business mailing address

PO BOX 68
MOUNT VERNON MO
65712-0068
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026046967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: