Provider Demographics
NPI:1578783684
Name:JACOBS, DEBRA ANN
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:OK
Mailing Address - Zip Code:74563-0208
Mailing Address - Country:US
Mailing Address - Phone:918-465-3911
Mailing Address - Fax:
Practice Address - Street 1:312 SE 5TH STREET
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578
Practice Address - Country:US
Practice Address - Phone:918-465-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist