Active NPI
Kevin M Jacoby, MSN, RN, APNP
- Family Nurse Practitioner
- Milwaukee, WI
National Provider Identifier
1679850747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4684-33
- Practice address
- 5000 W Chambers St
Milwaukee, WI 53210-1650 - Phone
- (414) 874-4316
- Fax
- (414) 874-4160
- NPI assigned
- Nov 3, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4684-33 | WI | Primary |
Addresses
Primary practice location
5000 W Chambers St
Milwaukee, WI 53210-1650
Mailing address
972 N Green Bay Rd
Grafton, WI 53024-1527
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)
- Enrolled
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4684 | WI | MD | General Practice Dentistry |
| 4684-33 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1679850747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "972 N GREEN BAY RD",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530241527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 W CHAMBERS ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532101650",
"telephone_number": "414-874-4316",
"fax_number": "414-874-4160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBY",
"first_name": "KEVIN",
"middle_name": "M",
"credential": "MSN, RN, APNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-03",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "4684-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.