CAROLINE N JACOBS (NPI# 1306158548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306158548 |
| Entity Type | Individual |
| Full Name | CAROLINE N JACOBS |
| Credential | PHD, APRN |
| Practice Address |
4804 Nw Bethany Blvd Ste I-2, #142 Portland OR 97229 |
| Mailing Address |
4804 Nw Bethany Blvd. Ste I-2, #142 Portland OR 97229 |
| Practice Telephone | (503) 332-6000 |
| Mailing Telephone | (503) 332-6000 |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP60167711 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR & INDUSTRIES | 0271524 | 01 |
| WA | 1306158548 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5170 Nw Millstone Way, Portland, OR 972291845 | 5033326000 |
| Street Address |
4804 NW BETHANY BLVD STE I-2, #142 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97229 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114324597 | Fitness & Function LLC | Physical Therapist | 4804 Nw Bethany Blvd, Suite 12 #167, Portland, OR 97229-9195 | 2014-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851919906 | Anjana Rajan | Counselor | Lifeworks Northwest, 14600 Nw Cornell Rd, Portland, OR 97229 | 2020-07-06 |
| 1871138453 | Kedrick Starr | Case Manager/Care Coordinator | 14600 Nw Cornell Rd., Portland, OR 97229 | 2019-11-07 |
| 1477102689 | Raquel A Bishop | Nurse Practitioner | 12400 Nw Cornell Rd Ste 100, Portland, OR 97229 | 2019-09-10 |
| 1669026134 | Alexandra Elizabeth Lodwig | Speech-Language Pathologist | 255 Nw Lost Springs Terrace Apt 304, Portland, OR 97229 | 2019-08-01 |
| 1003316043 | Jenny Lavonne Thom | Counselor | 15220 Nw Laidlaw Rd., Suite 280, Portland, OR 97229 | 2018-02-16 |
| 1194230664 | Ankita Guchait | Case Manager/Care Coordinator | 14600 Nw Cornell Rd, Portland, OR 97229 | 2017-12-06 |
| 1568988913 | Hannah Hendrix Klingelheber | Speech-Language Pathologist | 15605 Nw Ryegrass St., Portland, OR 97229 | 2017-08-17 |
| 1548791213 | Adeline Mitchell | Registered Nurse | 14600 Sw Cornell Rd., Portland, OR 97229 | 2017-03-24 |
| 1538610670 | Crystal Graves | Peer Specialist | 14600 Nw Cornell, Portland, OR 97229 | 2016-10-24 |
| 1639533185 | Evelin James | Dental Hygienist | 5879 Nw Lark Meadow Ter, Portland, OR 97229 | 2016-04-11 |
| Find all providers in zip 97229 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154920148 | Hardcore Happy LLC | Nurse Practitioner | 740 Ne 116th Ct, Portland, OR 97220-2223 | 2020-10-20 |
| 1457967325 | Megan L Langworthy | Nurse Practitioner | 1914 Se 46th Ave, Portland, OR 97215-3148 | 2020-09-16 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1730712290 | Lucy Anne Bloedon | Nurse Practitioner | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 |
| 1346802733 | Compass Psychiatric Wellness LLC | Nurse Practitioner | 4300 Ne Fremont St Ste 260, Portland, OR 97213-1100 | 2019-07-05 |
| 1548721871 | Cooke Therapy Pllc | Nurse Practitioner | 1125 Se Madison St Ste 102, Portland, OR 97214-3600 | 2019-03-28 |
| 1245719541 | Scott J Whited | Nurse Practitioner | 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 | 2018-08-08 |
| 1467969220 | Nw Mind-body Wellness, LLC | Nurse Practitioner | 16986 Nw Lynch Ln, Portland, OR 97229-1221 | 2018-01-02 |
| 1811441348 | Anthony Hoy | Nurse Practitioner | 5562 Se Pine St, Portland, OR 97215-1276 | 2016-08-12 |
| 1700241254 | Jacqueline J Cole | Nurse Practitioner | 5228 Ne Hoyt St Ste 300, Portland, OR 97213-3055 | 2015-12-29 |
| Find all providers in PORTLAND | ||||
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| 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.