MEDICARE: DR. NATALIE NELSEN JACOBSON DMD

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
1	122300000X	Dentist	9739	KY

General Provider Information

NPI Number	:	1861840357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE NELSEN JACOBSON DMD

Provider Business Mailing Address
First Line	:	502 MOUNT EDEN RD
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8871
Country	:	US
Telephone Number	:	502-633-1538
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 MOUNT EDEN RD
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8871
Country	:	US
Telephone Number	:	502-633-1538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	07/10/2019

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