Jacob Fancher
Individual provider Active NPI Rehabilitation Counselor · Edmonton, KY
NPI 1104461367 · NPPES record last updated Nov 12, 2019
Key facts
- NPI
- 1104461367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Counselor 225C00000X
- Practice address
- 112 Sartin Dr
Edmonton, KY 42129-8170 - Phone
- (270) 901-5000
- Fax
- (270) 842-5268
- NPI assigned
- Nov 12, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeskills, Inc. | Current |
Accepting new patients |
Locations
380 Suwannee Trail St
Bowling Green, KY 42103
112 Sartin Dr
Edmonton, KY 42129
Phone (270) 432-2266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Counselor | 225C00000X | Yes |
Addresses
Primary practice location
112 Sartin Dr
Edmonton, KY 42129-8170
Mailing address
380 Suwannee Trail St
Bowling Green, KY 42103-7956
Phone (270) 901-5000
Other providers in Edmonton, KY
- Kevin Emberton
- Tabatha M Engalnd
- Jill England
- Alysha Ervin
- Kela Everley
- Emily Jo Ferguson
- FH&L Family Practice LLC
- Angelia Ford
- Mark Wayne Froedge
- Tina Froedge
All providers in Edmonton, KY · Rehabilitation Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.