Provider Demographics
NPI:1710036389
Name:JACOBS, CARHY GEETER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CARHY
Middle Name:GEETER
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 PHILLIPS COUNTY 241 ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXA
Mailing Address - State:AR
Mailing Address - Zip Code:72355-2302
Mailing Address - Country:US
Mailing Address - Phone:870-572-2216
Mailing Address - Fax:
Practice Address - Street 1:116 HICKORY HILLS DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-2302
Practice Address - Country:US
Practice Address - Phone:870-338-8844
Practice Address - Fax:870-338-8108
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2780171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor