JOHN JACOBS III
Nurse Practitioner (Acute Care)

Address: 3236 E Grand Ave Ste D, Laramie, WY 82070-5100

JOHN JACOBS III (NPI# 1497184378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497184378
Entity Type Individual
Full Name JOHN JACOBS III
Gender Male
Credential NP-C
Practice Address 3236 E Grand Ave Ste D
Laramie
WY 82070-5100
Practice Telephone 3077608602
Practice Fax Number 3074609880
Mailing Address 3236 E Grand Ave Ste D
Laramie
WY 82070-5100
Mailing Telephone 3077608602
Mailing Fax Number 3074609880
Enumeration Date 2013-11-01
Last Update Date 2018-11-14
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Grouping
Y 363LA2100X Nurse Practitioner
Specialization: Acute Care
193200000X MULTI-SPECIALTY GROUP 34286.1346 WY Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
RN2259982 MA Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
APN.0990808-NP CO Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifiers

Identifier State Issuer Type Code
P01679910 WY MEDICAID

Physician Overview

PECOS Associate Control (PAC) ID 8729217054
by Medicare Provider Enrollment and Chain/Ownership System (PECOS)
Professional Enrollment ID I20151111002271
Last Name JACOBS
First Name JOHN
Middle Name F
Suffix III
Organization Legal Name GRAND AVENUE URGENT CARE LLC
Location 3236 E Grand Ave, Suite D, Laramie, WY 82070-5100
Phone Number 3077608602
Medical School WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE
Graduation Year 2013
Primary Specialty NURSE PRACTITIONER
Group Practice PAC ID 4385936244
Number of Group Practice Members 4

Office Location

Street Address 3236 E GRAND AVE STE D
City LARAMIE
State WY
Zip Code 82070-5100

Providers in the same location

NPI Name Taxonomy Address Enumeration
1982051850 Chris Otto Physician Assistant - Medical 3236 E Grand Ave Ste D, Laramie, WY 82070-5100 2016-05-19
1477109445 Philip Lerory Sanders IIi Nurse Practitioner - Family 3236 E Grand Ave Ste D, Laramie, WY 82070-5100 2019-08-14
1174983118 Grand Avenue Urgent Care, LLC Clinic/Center - Urgent Care 3236 E Grand Ave Ste D, Laramie, WY 82070-5100 2016-03-03

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1124005988 Kurt S Johnson · Kurt S Johnson Family Medicine 3236 E Grand Ave, Suite G, Laramie, WY 82070-5100 2005-12-22
1215941638 Kurt S. Johnson, Md, PC Family Medicine 3236 E Grand Ave Ste G, Laramie, WY 82070-5100 2006-07-28

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1447685706 Dale Warren Van Wig Pharmacist 544 N. Third St, Pharmacy, Laramie, WY 82070 2013-09-05
1396968418 Carol Hammett Bress Counselor - Professional 217 S 1st St, Laramie, WY 82070 2007-04-10
1528146313 Debra Inez Shevick Dentist 402 E Custer St, Laramie, WY 82070 2006-11-01
1831211184 Charles W Denison Psychologist 217 S 1st, Laramie, WY 82070 2007-04-06
1316177371 Patricia Ann Casey Occupational Therapist Laramie Care Center, 503 S. 18th St., Laramie, WY 82070 2009-07-23
1700093374 Michael M. Morgan Marriage & Family Therapist 1213 E. Grand Ave., Laramie, WY 82070 2007-05-16
1215955885 Randall Lee Martin Anesthesiology 204 Mccollum Drive, Suite 101, Laramie, WY 82070 2006-07-18
1811103583 Thomas Mcgarvey Dentist 303 S. 8th St., Laramie, WY 82070 2007-05-16
1134322340 Linda K Cross Case Manager/Care Coordinator 315 So 8th, Laramie, WY 82070 2007-06-06
1528429917 Spark Community/Behavioral Health 903 S 9th Street, Laramie, WY 82070 2016-03-11
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Taxonomy Information

Taxonomy Code 363LA2100X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Acute Care

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1992310999 Integrative Health Specialists, LLC Nurse Practitioner - Acute Care 304 Coffeen Ave Ste A, Sheridan, WY 82801-4803 2020-09-15
1477061836 Leesa Marie Belus Nurse Practitioner - Acute Care 1842 Sugarland Dr Ste 103, Sheridan, WY 82801-5719 2018-01-18
1093248114 Donald Coulter Nurse Practitioner - Acute Care 3632 American Way, Casper, WY 82604-3164 2017-04-05
1336797166 Krisinda Michelle White · Krisinda Michelle Caywood Nurse Practitioner - Acute Care 214 E 23rd St, Cheyenne, WY 82001-3748 2019-08-26
1720589591 Kristen Rebecca Dobbin Nurse Practitioner - Acute Care 2360 E Pershing Blvd, Cheyenne, WY 82001-5356 2018-02-26
1972051423 Stephanie M Davis Nurse Practitioner - Acute Care 1230 E 1st St, Casper, WY 82601-2704 2016-09-13
1619330149 Sarah Lynn Frank Nurse Practitioner - Acute Care 4140 Centennial Hills Blvd Ste A, Casper, WY 82609 2016-04-01
1447671920 Robin Horsley Nurse Practitioner - Acute Care 1401 W 5th St, Sheridan, WY 82801-2705 2013-12-30
1699732503 Keri Rae Pulley Nurse Practitioner - Acute Care 2360 E Pershing Blvd, Cheyenne, WY 82001-5356 2006-04-26

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1093399958 Rebecca Griffin Nurse Practitioner - Acute Care 7917 W Colette Cir, Unit 61, Tucson, AZ 85710 2021-05-07
1245814136 Ursula Cabauatan Nurse Practitioner - Acute Care 27700 Highway 290 Ste 400, Cypress, TX 77433-6767 2021-05-07
1508440694 Angela Kamal Itty Nurse Practitioner - Acute Care 7 Folklore Ct, The Woodlands, TX 77389-6934 2021-05-06
1245814250 Abby Elizabeth Dossett Nurse Practitioner - Acute Care 801 Saint Marys Dr Ste 205w, Evansville, IN 47714-0556 2021-05-06
1306420229 Sarah Marie Garcia Nurse Practitioner - Acute Care 1209 Tulip St Apt 6c, Longmont, CO 80501-3153 2021-05-06
1336722545 Lisa Montijo Nurse Practitioner - Acute Care 4 S Cascade Ave, Colorado Springs, CO 80903-1653 2021-05-04
1679156079 Lisa M Manse Nurse Practitioner - Acute Care 227 Harter Ave Nw, Canton, OH 44708-5528 2021-05-03
1770166175 Monica Yoon Nurse Practitioner - Acute Care 757 Westwood Plz Ste B790a, Los Angeles, CA 90095-8358 2021-05-03
1467035931 Ashlyn Clarise Kelley Nurse Practitioner - Acute Care 1331 N 7th St Ste 405, Phoenix, AZ 85006-2754 2021-05-03
1497338958 Athmar Mary Yaldo Nurse Practitioner - Acute Care 12032 Calle De Medio Unit 169, El Cajon, CA 92019-4937 2021-05-03
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Competitor

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City LARAMIE
Zip Code 82070

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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