Provider Demographics
NPI:1972869501
Name:JACOBS, KAREN JO (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JO
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JO
Other - Last Name:DONAHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:634 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-3336
Mailing Address - Country:US
Mailing Address - Phone:870-780-6986
Mailing Address - Fax:870-780-6897
Practice Address - Street 1:634 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-3336
Practice Address - Country:US
Practice Address - Phone:870-780-6986
Practice Address - Fax:870-780-6897
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR26378163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent