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General NPI Number Information
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NPI Number | 1295161933
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Entity Type | Individual
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Provider Name | STACEY L JACOBS NP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1319 DUNCAN AVE
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3759
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Country | US
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Telephone | 812-283-2308
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Fax | 812-283-2832
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Provider Business Mailing Address
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Address Line | 1319 DUNCAN AVE FAMILY HEALTH CENTER CLARK COUNTY
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3759
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Country | US
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Telephone | 812-283-2308
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Fax | 812-283-2832
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3010254
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71004631B
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License Number State | IN
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