Active NPI
Desha Perry Jacobs, RN, CDE
- Health Educator
- Indian Trail, NC
National Provider Identifier
1275973612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 164318
- Practice address
- 4505 Sages Ave
Indian Trail, NC 28079-6621 - Phone
- (704) 493-2087
- NPI assigned
- Jun 30, 2013
- 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 |
|---|---|---|---|---|
| Health Educator | 174H00000X | 164318 | NC | Primary |
Addresses
Primary practice location
4505 Sages Ave
Indian Trail, NC 28079-6621
Mailing address
4505 Sages Ave
Indian Trail, NC 28079-6621
Phone (704) 493-2087
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2092-0582 | Other | NC | NATIONAL CERTIFICATION BOARD FOR DIABETIC EDUCATORS |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164318 | NC | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1275973612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4505 SAGES AVE",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280796621",
"telephone_number": "704-493-2087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4505 SAGES AVE",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280796621",
"telephone_number": "704-493-2087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "DESHA",
"middle_name": "PERRY",
"credential": "RN, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-30",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NC",
"license": "164318",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL CERTIFICATION BOARD FOR DIABETIC EDUCATORS",
"identifier": "2092-0582",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indian Trail, NC
- Indian Trail Specific Chiropractic Inc (Carolinas Family Spine Center)
- Infinity Dental Arts
- Innercity Transportation LLC
- Integrative Chiropractic and Natural Medicine
- Christian Tyler Jackson
- Tracey L. Jaglal, MS, CCC-SLP
- Jaki Med Inc
- James F. Matthews OD PA
- Nancy Viola James, A-GNP
- Vanessa Starr James, LLMSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.