Provider Demographics
NPI:1003122201
Name:HARVEY, JACOB WILLIAM JR (APRN-FNP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WILLIAM
Last Name:HARVEY
Suffix:JR
Gender:M
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2128
Mailing Address - Country:US
Mailing Address - Phone:502-377-1406
Mailing Address - Fax:
Practice Address - Street 1:516 W BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2128
Practice Address - Country:US
Practice Address - Phone:502-648-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006597363LF0000X
KY6597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100136720Medicaid
KY7100136720Medicaid