Healthcare Provider Details

I. General information

NPI: 1205740339
Provider Name (Legal Business Name): ELLA NICOLE JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 W 39TH ST APT 118
KEARNEY NE
68845-8230
US

IV. Provider business mailing address

2201 UNIVERSITY DRIVE APT. 118
KEARNEY NE, 68847 NE
68847
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-6834
  • Fax:
Mailing address:
  • Phone: 308-991-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: