Individual provider Active NPI

Autum Renee Jacobs, FNP-BC

  • Family Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1235954926
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
314886 Issued in AZ
Practice address
820 Ainsworth Dr Ste a
Prescott, AZ 86301-1613
Phone
(928) 771-5548
Fax
(928) 771-5549
NPI assigned
Nov 19, 2024
Last updated
Sep 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 314886 AZ Primary
Gastroenterology Physician 207RG0100X 314886 AZ

Addresses

Primary practice location

820 Ainsworth Dr Ste a
Prescott, AZ 86301-1613

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Other practice location 1

6648 N Viewpoint Dr Ste 5
Prescott Valley, AZ 86315-4942
Phone (928) 771-5548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241204004098 AZ Practitioner - Nurse Practitioner 8820524531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone (928) 771-3704

6648 N Viewpoint Dr
Suite 5
Prescott Valley, AZ 86315-4942
Phone (928) 708-4800

810 Ainsworth Dr
Prescott, AZ 86301-1612

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
314886AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC Family Medicine CurrentSince Dec 1, 2024 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Dec 1, 2024 Accepting new patients
Prescott Gastroenterology Gastroenterology Past Accepting new patients

Locations

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

810 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 445-9660

820 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 777-5800

6648 N Viewpoint Dr
Ste 5
Prescott Valley, AZ 86315
Phone (928) 708-4800

Organizations & group practices 4

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1235954926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 AINSWORTH DR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011613",
            "telephone_number": "928-771-5548",
            "fax_number": "928-771-5549"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6648 N Viewpoint Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863154942",
            "country_code": "US",
            "telephone_number": "928-771-5548",
            "fax_number": "928-458-2130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "AUTUM",
        "middle_name": "RENEE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-19",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "314886",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "314886",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.