Provider Demographics
NPI:1992042279
Name:JACOBSON, MEGAN OLIVER (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:OLIVER
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5314
Mailing Address - Country:US
Mailing Address - Phone:325-646-5296
Mailing Address - Fax:325-646-5820
Practice Address - Street 1:1604 14TH ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5314
Practice Address - Country:US
Practice Address - Phone:325-646-5296
Practice Address - Fax:325-646-5820
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08054363AS0400X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08054OtherSTATE
13581476OtherCAQH
TXPA08054OtherSTATE