Healthcare Provider Details

I. General information

NPI: 1336080159
Provider Name (Legal Business Name): JACOB SCOTT KLEIN RN, BSN, NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 CHRISTINA LN
POPLAR BLUFF MO
63901-8854
US

IV. Provider business mailing address

322 CHRISTINA LN
POPLAR BLUFF MO
63901-8854
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-1600
  • Fax: 573-472-7296
Mailing address:
  • Phone: 573-471-1600
  • Fax: 573-472-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2023021981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: