Selin K Jacob, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP-02040 Issued in NM

Practice address

444 W Fort St FL 2
Boise, ID 83702-4535

Phone

(208) 422-1018

NPI assigned

Oct 19, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Selin K Varghese Former name

Medicare fee-for-service enrollment

Enrolled in NM

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

Nurse Practitioner

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

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1780937359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 VENETIAN LOOP",
            "address_2": "LAS CRUCES",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114126",
            "telephone_number": "575-640-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 W FORT ST FL 2",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024535",
            "telephone_number": "208-422-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "SELIN",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-19",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-02040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SELIN",
            "last_name": "VARGHESE",
            "middle_name": "K",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Keri Lynn Jackson, M.D.
• Leah Jackson, ARNP
• Leah Irene Jackson, LMSW
• Yvette Lisa Jackson, LCSW
• Beth Anne Jacob, OTR/L
• Brandy Renee' Jacobs, CSFA
• Hilary Jacobs
• Jessica Dianna Jacobs
• Joanne Jacobs, PHARM D
• Katie Conlon Jacobs, LCPC

• Family Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.