Provider Demographics
NPI:1265730311
Name:JACOB, LORI (APRN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-253-4914
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1024 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2311
Practice Address - Country:US
Practice Address - Phone:859-241-2148
Practice Address - Fax:859-241-2934
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2020-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY1083901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner