Provider Demographics
NPI:1972186864
Name:JACOBS, URSULA MEKEDA
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:MEKEDA
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 1:9415 BRUTON RD APT 1407
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-2576
Mailing Address - Country:US
Mailing Address - Phone:972-481-4491
Mailing Address - Fax:
Practice Address - Street 1:9415 BRUTON RD APT 1407
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-2576
Practice Address - Country:US
Practice Address - Phone:972-481-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty