Provider Demographics
NPI:1801610209
Name:KNOX, JACOB PARKER (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:PARKER
Last Name:KNOX
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 DICKSON DR NE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-7710
Mailing Address - Country:US
Mailing Address - Phone:502-888-5732
Mailing Address - Fax:
Practice Address - Street 1:13050 MAGISTERIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5181
Practice Address - Country:US
Practice Address - Phone:502-225-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4030444363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty