JACOB MAYBERRY (NPI# 1437311081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437311081 |
| Entity Type | Individual |
| Full Name | JACOB MAYBERRY |
| Credential | AS-C |
| Practice Address |
104 Blue Water Dr Bridgeport TX 76426-4336 |
| Practice Telephone | 9406838078 |
| Practice Fax Number | 9406838078 |
| Mailing Telephone | 9406838078 |
| Mailing Fax Number | 9406838078 |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-06-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364S00000X | Clinical Nurse Specialist | TC08-0326A | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
104 BLUE WATER DR |
| City | BRIDGEPORT |
| State | TX |
| Zip Code | 76426-4336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184950784 | Jacob Mayberry Assisting Services | Physician Assistant | 104 Blue Water Dr, Bridgeport, TX 76426-4336 | 2009-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790169613 | Victor Esmeraldo | Dentist | 1808 Chico Hwy, Bridgeport, TX 76426 | 2015-07-10 |
| 1376941013 | K&h Dental Pa | Clinic/Center | 1808 Chico Highway, Bridgeport, TX 76426 | 2014-12-11 |
| 1710252572 | Jonathon Stanley Scarborough | Nurse Anesthetist, Certified Registered | 1509 Dr. Hospital Drive, Bridgeport, TX 76426 | 2012-03-13 |
| 1124153010 | Christopher Aaron Hicks | Physical Therapist | 707 Woodrow Wilson Ray Cir, Bridgeport, TX 76426 | 2007-02-22 |
| 1578636411 | 34hha, Inc | Home Health | 401 Center Ct., Bridgeport, TX 76426 | 2006-11-16 |
| 1295777902 | West 380 Nursing Center | Assisted Living Facility | 2108 15th St, Bridgeport, TX 76426 | 2006-06-10 |
| 1780810234 | Scc Partners Inc | Skilled Nursing Facility | 2108 15th St, Bridgeport, TX 76426 | 2009-06-10 |
| 1477175628 | Noemi Araceli Meza | Non-emergency Medical Transport (VAN) | 1006 Newby Ave, Bridgeport, TX 76426-2030 | 2020-05-11 |
| 1992013692 | Bridgeport Isd | Local Education Agency (LEA) | 2107 15th St, Bridgeport, TX 76426-2052 | 2010-09-16 |
| 1952853194 | City of Ennis | Skilled Nursing Facility | 2108 15th St, Bridgeport, TX 76426-2055 | 2016-11-03 |
| Find all providers in zip 76426 | ||||
| Taxonomy Code | 364S00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |
| Notes: Sources: American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue and The Interagency Conference on Nursing Statistics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205917655 | Lynn B Rakos | Clinical Nurse Specialist | Southwest Ct Mental Health System Attn Sandra Grazynski, 1635 Central Avenue, Bridgeport, CT 06610 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962016519 | Jennie Rose Posey | Clinical Nurse Specialist | 6500 N. Mopac Expressway, Building 3, Suite 200, Austin, TX 78731 | 2020-09-01 |
| 1144843103 | Katie Elaine Malone | Clinical Nurse Specialist | 1325 Pennsylvania Ave Ste 500, Fort Worth, TX 76104-2130 | 2020-05-26 |
| 1912561051 | Princess Rollins Holt | Clinical Nurse Specialist | 2300 Highland Village Rd Ste 300, Highland Village, TX 75077-7157 | 2019-04-24 |
| 1538646062 | William Stone | Clinical Nurse Specialist | 1400 Clarewood Dr Apt 325, San Marcos, TX 78666-8034 | 2018-07-26 |
| 1831680040 | Carmen Floy Lagrone | Clinical Nurse Specialist | 6901 Mckinney Falls Pkwy, Austin, TX 78744-8401 | 2018-05-23 |
| 1891206835 | Rebecca Robles | Clinical Nurse Specialist | 2500 West Fwy Ste 200, Fort Worth, TX 76102-5851 | 2017-10-17 |
| 1467970145 | Kimberley Gayle Brooks | Clinical Nurse Specialist | 507 Denali Pass, Cedar Park, TX 78613 | 2017-09-01 |
| 1932637378 | Virginia Ducote Remeny | Clinical Nurse Specialist | 4316 Companeros Way, Austin, TX 78749-3650 | 2017-05-30 |
| 1689101651 | Mary Beth Mollenkopf | Clinical Nurse Specialist | 1130 Hoffman Rd, Seguin, TX 78155-0956 | 2017-05-21 |
| 1821532565 | Equilibre Clinic LLC | Clinical Nurse Specialist | 6025 Metropolitan Dr Ste 210, Beaumont, TX 77706-2409 | 2016-12-15 |
| Find all providers with the same taxonomy | ||||
| City | BRIDGEPORT |
| Zip Code | 76426 |
Please comment or provide details below to improve the information on JACOB MAYBERRY.
| 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.