Provider Demographics
NPI:1053466763
Name:JACOBS, MACARA K (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MACARA
Middle Name:K
Last Name:JACOBS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14369
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-4369
Mailing Address - Country:US
Mailing Address - Phone:314-567-6071
Mailing Address - Fax:
Practice Address - Street 1:12855 N 40 DR STE 350
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8669
Practice Address - Country:US
Practice Address - Phone:314-567-6071
Practice Address - Fax:314-453-9965
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024022107363AM0700X
IL085.010556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical