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NPI Code Detail

MEDICARE: JENESSA JACOBSEN RECOVERY ASSISTANT

MEDICARE: JENESSA JACOBSEN RECOVERY ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorAR
2106S00000XBehavior TechnicianAR

General Provider Information

NPI Number : 1104298447
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENESSA JACOBSEN RECOVERY ASSISTANT
Provider Business Mailing Address
First Line : 301 N SIDNEY AVE
Second Line :
City : RUSSELLVILLE
State : AR
Zip : 72801-4383
Country : US
Telephone Number : 479-890-5494
Fax Number : 479-498-9665
Provider Business Practice Location Address
First Line : 301 N SIDNEY AVE
Second Line :
City : RUSSELLVILLE
State : AR
Zip : 72801-4383
Country : US
Telephone Number : 479-890-5494
Fax Number : 479-498-9665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2015
Last Update Date : 12/28/2023

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