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General NPI Number Information
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NPI Number | 1538806179
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Entity Type | Individual
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Provider Name | MS. CHARLENE JACOBS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 320 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-7630
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Country | US
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Telephone | 504-416-1840
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 KINLER ST
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City | LULING
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State | LA
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Zip | 70070-4533
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Country | US
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Telephone | 504-416-1840
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 441590119
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License Number State | LA
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