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General NPI Number Information
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NPI Number | 1063127967
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Entity Type | Individual
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Provider Name | RANDI JACOBS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 170 N EAGLE CREEK DR STE 104
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City | LEXINGTON
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State | KY
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Zip | 40509-9087
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Country | US
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Telephone | 859-967-5848
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Fax | 859-967-5473
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | LONDON
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State | KY
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Zip | 40743-0936
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Country | US
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Telephone | 859-967-5748
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Fax | 859-967-5473
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3018860
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License Number State | KY
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