Provider Demographics
NPI:1316696180
Name:VINSON, JACOB COLBY
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:COLBY
Last Name:VINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:COLBY
Other - Middle Name:
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:144 DENALI WAY
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-0122
Mailing Address - Country:US
Mailing Address - Phone:972-838-3996
Mailing Address - Fax:
Practice Address - Street 1:925 CITY CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2981
Practice Address - Country:US
Practice Address - Phone:936-202-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program