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General NPI Number Information
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NPI Number | 1154555761
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Entity Type | Individual
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Provider Name | TRAVIS LEE JACOBS PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 10015 N. AMBASSADOR DRIVE
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City | KANSAS CITY
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State | MO
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Zip | 64153-1365
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Country | US
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Telephone | 816-595-4000
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Fax | 816-595-4001
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Provider Business Mailing Address
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Address Line | 521 E 117TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64131-3805
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Country | US
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Telephone | 315-778-8749
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1086052
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MO
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