Provider Demographics
NPI:1629964291
Name:MCCRACKIN, JACOB HENRY
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:HENRY
Last Name:MCCRACKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2434
Mailing Address - Country:US
Mailing Address - Phone:417-274-9625
Mailing Address - Fax:
Practice Address - Street 1:1480 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2010
Practice Address - Country:US
Practice Address - Phone:417-256-5669
Practice Address - Fax:417-256-5699
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist