Caroline N Jacobs, PHD, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60167711 Issued in WA

Practice address

4804 NW Bethany Blvd
Ste I-2, #142
Portland, OR 97229

Phone

(503) 332-6000

NPI assigned

Jul 3, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Cowlitz Indian Tribe

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Vancouver, WA
  • NPI 1538412630
  NPD (past)

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

{
    "created_epoch": "1278115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1306158548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4804 NW BETHANY BLVD.",
            "address_2": "STE I-2, #142",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97229",
            "telephone_number": "503-332-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 NW BETHANY BLVD",
            "address_2": "STE I-2, #142",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97229",
            "telephone_number": "503-332-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5170 NW Millstone Way",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972291845",
            "country_code": "US",
            "telephone_number": "503-332-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "CAROLINE",
        "middle_name": "N",
        "credential": "PHD,  APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60167711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0271524",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306158548",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Jacob, LMT
• Tirzah D Jacob, LPC
• Christy Jacobo, RN
• Kimberly Jacobowitz, LCSW
• Betony M Jacobs
• Chad Christopher Jacobs, MED, LPC
• Christopher John Jacobs, B.S
• Emily Jacobs
• Gabrielle Jacobs
• Heather Jacobs, MPA, NBC-HWC

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.