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General NPI Number Information
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NPI Number | 1043175003
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Entity Type | Individual
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Provider Name | JACOB MCKINLEY MANESS
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Gender | Male
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 9550 HIGHWAY 412 W
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City | LEXINGTON
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State | TN
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Zip | 38351-5849
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Country | US
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Telephone | 731-968-8197
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Fax |
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Provider Business Mailing Address
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Address Line | 65 ESSARY ST APT A
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City | LEXINGTON
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State | TN
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Zip | 38351-1588
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Country | US
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Telephone | 731-541-8200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10164
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License Number State | TN
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