Provider Demographics
NPI:1912480567
Name:JACOBS, VALARIE D (APRN)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:D
Last Name:JACOBS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 S KAYS DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-8402
Mailing Address - Country:US
Mailing Address - Phone:801-698-0544
Mailing Address - Fax:
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6236
Practice Address - Country:US
Practice Address - Phone:801-784-8414
Practice Address - Fax:385-213-0093
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348597-4405207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2018018306OtherANCC