Healthcare Provider Details

I. General information

NPI: 1053466763
Provider Name (Legal Business Name): MACARA K JACOBS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 HEFNER POINTE DR STE B
OKLAHOMA CITY OK
73120-5049
US

IV. Provider business mailing address

11100 HEFNER POINTE DR STE B
OKLAHOMA CITY OK
73120-5049
US

V. Phone/Fax

Practice location:
  • Phone: 405-400-8188
  • Fax:
Mailing address:
  • Phone: 405-400-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2024022107
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1593
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.010556
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: