Provider Demographics
NPI:1508226481
Name:JACOBS, MOLLY RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:RUTH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:RUTH
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:215 TREUHAFT BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7361
Mailing Address - Country:US
Mailing Address - Phone:606-277-0173
Mailing Address - Fax:606-277-0045
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:STE 8
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:606-277-0173
Practice Address - Fax:606-277-0045
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010144363LP2300X
TN0000022101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care