Provider Demographics
NPI:1518120062
Name:JACOB, KIMBERLY EMILE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EMILE
Last Name:JACOB
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SUNNY GAP RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8407
Mailing Address - Country:US
Mailing Address - Phone:501-514-1277
Mailing Address - Fax:866-551-1024
Practice Address - Street 1:131 SUNNY GAP RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8407
Practice Address - Country:US
Practice Address - Phone:501-514-1277
Practice Address - Fax:866-551-1024
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR012005176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife