Nicole Jacobs, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2014-02452 Issued in NC

Practice address

195 West Illinois Avenue
Attn: April Smith
Southern Pines, NC 28387

Phone

(910) 692-2444

Fax

(910) 692-3031

NPI assigned

May 22, 2013

Last updated

Apr 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sandhills Pediatrics

  • Pediatrics Physician
  • Southern Pines, NC
  • NPI 1114998150

  Child & Adolescent Psychiatry

  NPD (past)

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1619313202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 WEST ILLINOIS AVENUE",
            "address_2": "ATTN: APRIL SMITH",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "28387",
            "telephone_number": "910-692-2444",
            "fax_number": "910-692-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 WEST ILLINOIS AVENUE",
            "address_2": "ATTN: APRIL SMITH",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "28387",
            "telephone_number": "910-692-2444",
            "fax_number": "910-692-3031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Grant Street",
            "address_2": "ATTN: April Smith",
            "address_purpose": "LOCATION",
            "city": "West End",
            "state": "NC",
            "postal_code": "27376",
            "country_code": "US",
            "telephone_number": "910-692-2444 x249",
            "fax_number": "910-692-3031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "116A Campus Avenue",
            "address_2": "ATTN: April Smith",
            "address_purpose": "LOCATION",
            "city": "Raeford",
            "state": "NC",
            "postal_code": "28376",
            "country_code": "US",
            "telephone_number": "910-692-2444 x249",
            "fax_number": "910-692-3031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-22",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2014-02452",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "2014-02452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Invictus Counseling
• Amy S. Ivey, C.P.N.P.
• Amanda R Jackson, BCAT
• Heather Jackson, LBMT
• Laura Permelia Jackson, M.S.ED.,ATC, LAT
• Fredena Lucas Jaggers, CRNA
• Thomas Scott Jamison, MD
• Jeffrey S. Almony, MD, DDS, PA (Southern Pines Oral & Maxillofacial Surgery Center)
• Jody McCain, PSYD PLLC
• Lindsay Johannes-Monroe, PH.D.

• Child & Adolescent Psychiatry Physician in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Child & Adolescent Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; 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.