Kellie L. Jacobs, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00028253 Issued in WA

Practice address

3500 Orchard PL
Bellingham, WA 98225-1749

Phone

(360) 671-3900

Fax

(360) 647-0882

NPI assigned

May 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Care Network PLLC

  • Family Medicine Physician
  • Bellingham, WA
  • NPI 1427001015
  NPD
• Family Care Network PLLC

  • Family Medicine Physician
  • Bellingham, WA
  • NPI 1558952150
  NPD
• Family Care Network PLLC

  • Family Medicine Physician
  • Bellingham, WA
  • NPI 1093747859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343088000000",
    "number": "1003863663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W ORCHARD DR",
            "address_2": "SUITE 4",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251766",
            "telephone_number": "360-318-8800",
            "fax_number": "360-318-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 ORCHARD PL",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251749",
            "telephone_number": "360-671-3900",
            "fax_number": "360-647-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KELLIE",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2012-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00028253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH COOPERATIVE",
            "identifier": "423898022",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080148055",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES (REG)",
            "identifier": "0130079",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8127276",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "14535",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES (CV)",
            "identifier": "8925030",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kinsey Jackson
• Stacey Marie Jackson, PTA
• Taylor Mae Jackson, CDPT
• Allison Joy Jacobs, DDS
• Diana P. Jacobs, PHD
• Pamela S Jacobs, PHD
• Jenna Jacobson, D.C.
• Leslie Jacobson, LMFT
• Margaret A Jacobson, MD
• Matthew Jacobson

• Family Medicine Physician in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.