Provider Demographics
NPI:1902003486
Name:JACOB, RUTH KELLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:KELLY
Last Name:JACOB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:311 23RD AVE N
Mailing Address - Street 2:SUITE #311
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1503
Mailing Address - Country:US
Mailing Address - Phone:615-340-5650
Mailing Address - Fax:615-340-2113
Practice Address - Street 1:311 23RD AVE N
Practice Address - Street 2:SUITE #311
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-5650
Practice Address - Fax:615-340-2113
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000109570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse