Jerome Jacob Jr.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

006065417 Issued in LA

Practice address

315 S College Rd Ste 220
Lafayette, LA 70503

Phone

(337) 380-8947

NPI assigned

Nov 10, 2015

Last updated

May 21, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1689047805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PHOENIX FAMILY LIFE CENTERS, 100 ASMA BLVD, SUITE 200,",
            "address_2": "PHOENIX FAMILY LIFE CENTERS, 100 ASMA BLVD, SUITE 200,",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033221",
            "telephone_number": "337-380-8947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S COLLEGE RD STE 220",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70503",
            "telephone_number": "337-380-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JEROME",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-11-10",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "LA",
            "license": "006065417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy James Jackson, NP
• Valerie Perrault Jackson, FNP
• Jacob Dent, DDS Lafayette Modern Dentistry, a Professional Corporation (Lafayette Modern Dentistry)
• Jacob L Breaux, MD, LLC
• Jacob R Karr, MD, LLC
• April E Jacobs, LPC
• Dwayne Jacobs, LPC, 6090
• Kelly D Jacobs, FNP
• Leslie J Jacobs, DDS
• Sheresa Jacobs

• Case Manager/Care Coordinator in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.