Provider Demographics
NPI:1053466763
Name:JACOBS, MACARA K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MACARA
Middle Name:K
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 HEFNER POINTE DR STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5049
Mailing Address - Country:US
Mailing Address - Phone:405-400-8188
Mailing Address - Fax:
Practice Address - Street 1:11100 HEFNER POINTE DR STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5049
Practice Address - Country:US
Practice Address - Phone:405-400-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical