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General NPI Number Information
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NPI Number | 1053466763
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Entity Type | Individual
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Provider Name | MACARA K JACOBS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 12855 N 40 DR STE 350
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8669
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Country | US
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Telephone | 314-567-6071
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Fax | 314-453-9965
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Provider Business Mailing Address
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Address Line | PO BOX 14369
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City | SAINT LOUIS
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State | MO
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Zip | 63178-4369
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Country | US
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Telephone | 314-567-6071
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2024022107
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085.010556
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License Number State | IL
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