Provider Demographics
NPI:1720042542
Name:JACOBY, DELWIN B (DNP, ARNP,)
Entity Type:Individual
Prefix:MRS
First Name:DELWIN
Middle Name:B
Last Name:JACOBY
Suffix:
Gender:F
Credentials:DNP, ARNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 CORPORATE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5416
Mailing Address - Country:US
Mailing Address - Phone:859-277-9436
Mailing Address - Fax:859-277-1765
Practice Address - Street 1:549 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1612
Practice Address - Country:US
Practice Address - Phone:859-367-7400
Practice Address - Fax:859-367-6194
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1042113163W00000X
KY3000960363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00603002Medicare PIN
KYR38156Medicare UPIN