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General NPI Number Information
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NPI Number | 1609581487
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Entity Type | Individual
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Provider Name | JESSICA JACOBS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 101 TONEY DR
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City | ARP
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State | TX
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Zip | 75750-5024
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Country | US
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Telephone | 903-859-4917
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 W CUMBERLAND RD APT 811
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City | TYLER
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State | TX
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Zip | 75703-7855
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Country | US
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Telephone | 405-924-0551
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT9454
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License Number State | TX
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