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General NPI Number Information
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NPI Number | 1982361127
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Entity Type | Individual
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Provider Name | KATHY ANN JACOBSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 275 W 17TH PL
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City | YUMA
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State | AZ
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Zip | 85364-5705
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Country | US
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Telephone | 928-344-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 2462 S TERRACE AVE
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City | YUMA
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State | AZ
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Zip | 85365-1108
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Country | US
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Telephone | 928-261-9268
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 266614
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License Number State | AZ
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