Provider Demographics
NPI:1992089627
Name:JACOB, GEETHA POWERS (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:GEETHA
Middle Name:POWERS
Last Name:JACOB
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 WHITESBURG DR SW STE 30-222
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1698
Mailing Address - Country:US
Mailing Address - Phone:954-297-5474
Mailing Address - Fax:
Practice Address - Street 1:4800 WHITESPORT CIR SW STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6443
Practice Address - Country:US
Practice Address - Phone:256-533-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153016363LF0000X, 363LP0808X
MSR883871363LF0000X
CA95000043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily