Kimberly Jo Jacobs, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01252 Issued in TX

Practice address

1507 W Main St
Gatesville, TX 76528-1024

Phone

(254) 865-2166

Fax

(254) 248-0626

NPI assigned

Dec 28, 2006

Last updated

Mar 18, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjacobs@cmhs.securechart.com

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.

• Coryell County Memorial Hospital Authority

  dba Coryell Memorial Healthcare System

  • Anesthesiology Physician
  • Gatesville, TX
  • NPI 1992832521
  Medicare reassignment
• Coryell County Memorial Hospital Authority

  dba Hillside Medical Lodge

  • Skilled Nursing Facility
  • Gatesville, TX
  • NPI 1427345347
  NPD
• Coryell County Memorial Hospital Authority

  dba Coryell Health

  • Emergency Medicine Physician
  • Gatesville, TX
  • NPI 1528195062
  NPD
• Belington Community Medical Services Association Inc

  dba Myers Clinic

  • Family Medicine Physician
  • Philippi, WV
  • NPI 1366446015

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1316003064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 W MAIN ST",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "765281024",
            "telephone_number": "254-865-2166",
            "fax_number": "254-248-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 W MAIN ST",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "765281024",
            "telephone_number": "254-865-2166",
            "fax_number": "254-248-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KIMBERLY",
        "middle_name": "JO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KJacobs@cmhs.securechart.com",
            "affiliation": "N",
            "endpointDescription": "Coryell Health Direct Messaging Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1507 W Main St",
            "city": "Gatesville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765281024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Austin E Horrocks, DO
• David Lyon Hudson, MD
• Aaron Gary Humphreys, MD
• Roxanne Michelle Hunter, PT, DPT
• Richard Kenneth Hurley, M.D.
• Jacqueline Mildred Jones
• Karly Ashlyn Keith
• Joseph Miller Kenworthy III, D.D.S.
• Kelly Nicole Kilgore
• Carl John Kornman, MD

• Physician Assistant in Gatesville, TX
• Providers in Gatesville, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.