Lee, Jacob Cole

Lee, Jacob Cole is an individual health care provider with primary practice located at 7545 Airways Blvd , Southaven MS 38671-5806. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Lee, Jacob Cole can be contacted via phone (901) 759-3100.

Contact Information

Primary practice address
7545 Airways Blvd Southaven MS 38671-5806
Phone: (901) 759-3100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1104431485
LBN Legal business name Lee, Jacob Cole
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2020
Last updated Oct 6th, 2022 - about 4 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 1104431485 NPPES
Tennessee MEDICAID Q063672
Tennessee MEDICAID 00827741

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