Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00028253 | WA |
NPI | 1003863663 |
---|---|
Provider Name | Dr. Kellie L. Jacobs |
First Address | Bellingham, WA 98225-1766 |
Second Address | Bellingham, WA 98225-1749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0130079 | LABOR & INDUSTRIES (REG) (01) | WA |
080148055 | RAILROAD MEDICARE (01) | WA |
14535 | REGENCE BLUESHIELD (01) | WA |
423898022 | GROUP HEALTH COOPERATIVE (01) | WA |
8127276 | (05) | WA |
8925030 | LABOR & INDUSTRIES (CV) (01) | WA |
E68230 | (02) | WA |