Provider Demographics
NPI:1326786716
Name:JACOBSON, KAITLYN MARIE (PA)
Entity type:Individual
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First Name:KAITLYN
Middle Name:MARIE
Last Name:JACOBSON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:975 RYLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1669
Practice Address - Country:US
Practice Address - Phone:775-982-4100
Practice Address - Fax:775-982-5225
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2024-08-02
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Provider Licenses
StateLicense IDTaxonomies
NVPA2704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant