Jacob Dylan Luke, RN

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

95345401 Issued in CA

Practice address

935B Spring St
Placerville, CA 95667-4523

Phone

(530) 621-6213

NPI assigned

Feb 5, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1114780764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 CEDAR OAK RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956677883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935B SPRING ST",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956674523",
            "telephone_number": "530-621-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKE",
        "first_name": "JACOB",
        "middle_name": "DYLAN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "95345401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Longs Drug Stores California LLC (CVS Pharmacy #09184)
• Kaelan Vincent Lopez, SUDRC
• Rene Loranca
• Jill Denise Lovejoy-Jackson, PTA, ATC
• Katherine Luckscheider
• Windy Lund
• Jenna Louise Lute
• Justin C. Luz, PT, DPT
• Natalie Lyman
• Joseph Macdonald

• Medical Specialty Clinic/Center in Placerville, CA
• Providers in Placerville, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.

Verify at the official NPI Registry.