Active NPI
Leanna Jacobs
- Physician Assistant
- Pembroke, NC
National Provider Identifier
1669242186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 812 Candy Park Rd
Pembroke, NC 28372-9120 - Phone
- (910) 512-0201
- NPI assigned
- Jan 5, 2024
- Last updated
- Jan 5, 2024
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary |
Addresses
Primary practice location
812 Candy Park Rd
Pembroke, NC 28372-9120
Mailing address
206 Mount Tabor Rd
Red Springs, NC 28377-6322
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
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Health of Carolina, PA | Past | Accepting new patients |
Interoperability endpoints
- leanna.jacobs.1@29216.direct.athenahealth.com
Organizations & group practices 1
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.
-
dba Children's Health Pembroke
- Pediatrics Physician
- Pembroke, NC
- NPI 1750345286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704412800000",
"number": "1669242186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 MOUNT TABOR RD",
"city": "RED SPRINGS",
"state": "NC",
"postal_code": "283776322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "812 CANDY PARK RD",
"city": "PEMBROKE",
"state": "NC",
"postal_code": "283729120",
"telephone_number": "910-512-0201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "LEANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-05",
"last_updated": "2024-01-05",
"certification_date": "2023-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.