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NPI Code Detail

MEDICARE: JACOB EMERY POWELL MS, BCBA, LBA

MEDICARE: JACOB EMERY POWELL MS, BCBA, LBA
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
1103K00000XBehavior Analyst163670KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-15-18467OTHERBCBA CERTIFICATE

General Provider Information

NPI Number : 1396298113
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB EMERY POWELL MS, BCBA, LBA
Provider Business Mailing Address
First Line : 112 DENNIS DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-2988
Country : US
Telephone Number : 859-308-1392
Fax Number :
Provider Business Practice Location Address
First Line : 112 DENNIS DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-2988
Country : US
Telephone Number : 859-308-1392
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2016
Last Update Date : 01/02/2026

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