Active NPI
Terrill Anastacia Jacobsen, CPSS
- Peer Specialist
- Kearney, NE
National Provider Identifier
1023631124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- CPSS-033
- Practice address
- 3810 Central Ave
Kearney, NE 68847-8134 - Phone
- (308) 237-5951
- Fax
- (308) 237-5953
- NPI assigned
- May 22, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CPSS-033 | NE | Primary |
Addresses
Primary practice location
3810 Central Ave
Kearney, NE 68847-8134
Mailing address
PO Box 1716
Kearney, NE 68848-1716
Phone (308) 237-5951
Other practice location 1
4111 4th Ave Ste 2
Kearney, NE 68845-2883
Phone (308) 237-1102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPSS-033 | NE | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1023631124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1716",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688481716",
"telephone_number": "308-237-5951",
"fax_number": "308-237-5953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3810 CENTRAL AVE",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688478134",
"telephone_number": "308-237-5951",
"fax_number": "308-237-5953"
}
],
"practiceLocations": [
{
"address_1": "4111 4th Ave Ste 2",
"address_purpose": "LOCATION",
"city": "Kearney",
"state": "NE",
"postal_code": "688452883",
"country_code": "US",
"telephone_number": "308-237-1102",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBSEN",
"first_name": "TERRILL",
"middle_name": "ANASTACIA",
"credential": "CPSS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-22",
"last_updated": "2024-03-26",
"certification_date": "2024-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NE",
"license": "CPSS-033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.