=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730048240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACOB POWERS FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 S HOUSTON LAKE RD STE 200
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-9094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-923-4403
-----------------------------------------------------
Fax | 478-923-8444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 S HOUSTON LAKE RD STE 200
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-9094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-923-4403
-----------------------------------------------------
Fax | 478-923-8444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN275742
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------