Provider Demographics
NPI:1912461625
Name:JACOBS, KESHIA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KESHIA
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3134
Mailing Address - Country:US
Mailing Address - Phone:716-912-2483
Mailing Address - Fax:
Practice Address - Street 1:837 AMHERST ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3134
Practice Address - Country:US
Practice Address - Phone:716-912-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308985-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse