Provider Demographics
NPI:1093364218
Name:JACOBS, KIM (RDN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27314 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:CO
Mailing Address - Zip Code:80117-8827
Mailing Address - Country:US
Mailing Address - Phone:720-480-0387
Mailing Address - Fax:
Practice Address - Street 1:2020 CANTERBURY DRIVE
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-623-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS86032961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered