Provider Demographics
NPI:1184232241
Name:JACOBS, KERRI
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
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 1:43500 S 356 RD
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-4555
Mailing Address - Country:US
Mailing Address - Phone:918-223-7694
Mailing Address - Fax:
Practice Address - Street 1:540 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2036
Practice Address - Country:US
Practice Address - Phone:918-762-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist