Jacobs, Kristen

Jacobs, Kristen is an individual health care provider with primary practice located at 329 Broadway St , Mount Vernon IL 62864-5115. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jacobs, Kristen can be contacted via phone (618) 244-3370.

Contact Information

Primary practice address
329 Broadway St Mount Vernon IL 62864-5115
Phone: (618) 244-3370
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X Illinois

Profile Details

NPI number 1457302655
LBN Legal business name Jacobs, Kristen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jul 24th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457302655 NPPES
Illinois MEDICAID 376020408007

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