Provider Demographics
NPI:1669447330
Name:JACOBSEN, JAMIE MULANAX (DO)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MULANAX
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:MULANAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11400 158TH RD
Mailing Address - Street 2:
Mailing Address - City:MAYETTA
Mailing Address - State:KS
Mailing Address - Zip Code:66509-8866
Mailing Address - Country:US
Mailing Address - Phone:785-966-8200
Mailing Address - Fax:785-966-8393
Practice Address - Street 1:11400 158TH RD
Practice Address - Street 2:
Practice Address - City:MAYETTA
Practice Address - State:KS
Practice Address - Zip Code:66509-8866
Practice Address - Country:US
Practice Address - Phone:785-966-8200
Practice Address - Fax:785-966-8393
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105010111N00000X
KS05-37969207P00000X
OK5231207Q00000X, 390200000X
KS0537969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111N00000XChiropractic ProvidersChiropractor
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0537969OtherSTATE LICENSE
KS0105010OtherSTATE LICENSE