Provider Demographics
NPI:1679997977
Name:RAPERT, JACOB ADAM
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ADAM
Last Name:RAPERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4973
Mailing Address - Country:US
Mailing Address - Phone:870-810-0171
Mailing Address - Fax:
Practice Address - Street 1:5935 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4973
Practice Address - Country:US
Practice Address - Phone:870-810-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator