Healthcare Provider Details

I. General information

NPI: 1437711330
Provider Name (Legal Business Name): LEXI SARA JACOBSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 KIETZKE LN BLDG A
RENO NV
89511-3019
US

IV. Provider business mailing address

5560 KIETZKE LN BLDG A
RENO NV
89511-3019
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-8152
  • Fax:
Mailing address:
  • Phone: 775-322-7811
  • Fax: 775-322-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2139
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPA2139
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: