Provider Demographics
NPI:1891987269
Name:JACOBS, MEGAN E (CPNP, PMHS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CPNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7194 KNIGHTBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8403
Mailing Address - Country:US
Mailing Address - Phone:317-417-7379
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36 STE 7
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6210
Practice Address - Country:US
Practice Address - Phone:765-721-6766
Practice Address - Fax:765-800-9013
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28153869A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics