Kevin S Jacobson, NP
Nurse Practitioner in Cooperstown, ND. Individual provider (NPI-1).
NPI number1528093077
StatusActive
Last updated in NPPESMay 23, 2012
Details
- NPI
- 1528093077
- Entity type
- Individual (NPI-1)
- Name
- Kevin S Jacobson
- Credential
- NP
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 12, 2006
- Last updated
- May 23, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | R27650 | ND | Yes |
| 363L00000X | Nurse Practitioner | R1561072 | MN |
Practice location
1200 Roberts Ave NeCooperstown Medical Center
Cooperstown, ND 58425-7101
Phone 701-797-2128
Mailing address
1200 Roberts Ave NeCooperstown Medical Center
Cooperstown, ND 58425-7101
Phone 701-797-2128
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