Provider Demographics
NPI:1467192203
Name:SOMMERS, JACOB (FNP)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:SOMMERS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36428 MANCHAC TRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3264
Mailing Address - Country:US
Mailing Address - Phone:225-252-2411
Mailing Address - Fax:
Practice Address - Street 1:36428 MANCHAC TRACE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3264
Practice Address - Country:US
Practice Address - Phone:225-252-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224082207Q00000X
TX1072336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine