JACOB LOUIS MUCKERMAN (NPI# 1275880429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1275880429 |
Entity Type | Individual |
Full Name | JACOB LOUIS MUCKERMAN |
Credential | FNP BC |
Practice Address |
1723 Broadway St Suite 410 Cape Girardeau MO 63701-4566 |
Practice Telephone | 5733391957 |
Practice Fax Number | 5733399709 |
Mailing Telephone | 5733391957 |
Mailing Fax Number | 5733399709 |
Enumeration Date | 2012-08-07 |
Last Update Date | 2012-08-10 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2012027450 | MO | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MO | MEDICAL LICENSE | 2012027450 | 01 |
Street Address |
1723 BROADWAY ST SUITE 410 |
City | CAPE GIRARDEAU |
State | MO |
Zip Code | 63701-4566 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801893979 | Pairote Jaroonwanichkul | Internal Medicine | 1723 Broadway St, Suite 315, Cape Girardeau, MO 63701-4505 | 2005-07-05 |
1639611718 | Jared Michael Lewis | Physician Assistant | 1723 Broadway St, Suite 410, Cape Girardeau, MO 63701-4566 | 2016-11-07 |
1043768088 | Tyler Joshua Greenwood | Physician Assistant | 1723 Broadway St, Suite 410, Cape Girardeau, MO 63701-4566 | 2016-09-20 |
1003115536 | Gladys Grace Tiwonge Kamanga-sollo | Physical Medicine & Rehabilitation | 1723 Broadway St, Suite 410, Cape Girardeau, MO 63701-4566 | 2011-03-23 |
1780982215 | Southeast Missouri Hospital Physicians LLC | Clinic/Center | 1723 Broadway St, Suite 205, Cape Girardeau, MO 63701-4566 | 2011-03-08 |
1679876767 | Magin Lea Chapman | Nurse Practitioner | 1723 Broadway St, Cape Girardeau, MO 63701-4566 | 2010-12-10 |
1821398678 | Andrew N Garner | Clinical Nurse Specialist | 1723 Broadway St, Cape Girardeau, MO 63701-4566 | 2010-10-27 |
1013222983 | Michele L Tanz | Nurse Practitioner | 1723 Broadway St, Suite 220, Cape Girardeau, MO 63701-4566 | 2010-08-16 |
1396066734 | Stephanie Lee Riley | Nurse Practitioner | 1723 Broadway St, Ste 410, Cape Girardeau, MO 63701-4566 | 2010-06-21 |
1407084890 | Jennifer Marie Lovegreen | Obstetrics & Gynecology | 1723 Broadway St, Suite 315, Cape Girardeau, MO 63701-4566 | 2009-06-24 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336748110 | Westbrook Dialysis, LLC | Clinic/Center | 140 West Drive, Cape Girardeau, MO 63701 | 2020-10-22 |
1972079580 | Savannah Laine Menard | Behavior Technician | 20 S. Sprigg St, Cape Girardeau, MO 63701 | 2018-10-22 |
1932690377 | Broadway Specialty, LLC | Pharmacy | 706 Broadway St, Cape Girardeau, MO 63701 | 2018-05-22 |
1356864649 | Terri L. Mccord | Pharmacist | 4170 Connor Dr, Cape Girardeau, MO 63701 | 2017-07-19 |
1013459312 | Christina Cossou | Nurse Practitioner | 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701 | 2016-11-17 |
1124573365 | Ashley Sullivan | Massage Therapist | 3041 Melrose Ave, Cape Girardeau, MO 63701 | 2016-08-17 |
1225432172 | Axpm - Merkley, LLC | Dentist | 2116 Megan Dr., Suite 101, Cape Girardeau, MO 63701 | 2014-10-21 |
1639573397 | Marian Perez Hurt | Physical Therapist | 2001 N. Kingshighway, Fountainbleau Lodge, Cape Girardeau, MO 63701 | 2014-10-09 |
1891194213 | Deanna Abner | Case Manager/Care Coordinator | 20 South Sprigg, Cape Girardeau, MO 63701 | 2014-08-21 |
1831506880 | Kwadwo O Britwum | Behavioral Analyst | Morningstar Behavioral Associates, 338 W. Broadway Suite 301, Cape Girardeau, MO 63701 | 2014-07-22 |
Find all providers in zip 63701 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144700147 | Taylor Babich | Nurse Practitioner | 1021 Emily Ct, Cape Girardeau, MO 63701-4569 | 2018-08-19 |
1659882546 | Morgan Reiminger | Nurse Practitioner | 171 Red Hawk Rdg, Cape Girardeau, MO 63701-8380 | 2017-10-18 |
1902316938 | Rebecca Susanne Williamson | Nurse Practitioner | 150 S Mount Auburn Rd Ste 320, Cape Girardeau, MO 63703-4911 | 2017-10-04 |
1194266528 | Janet Stewart | Nurse Practitioner | 1620 Scivally Dr, Cape Girardeau, MO 63701-2431 | 2017-03-18 |
1013459312 | Christina Cossou | Nurse Practitioner | 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701 | 2016-11-17 |
1497104814 | Emily Greenley | Nurse Practitioner | 150 S Mount Auburn Rd Ste 418, Cape Girardeau, MO 63703-4911 | 2016-06-07 |
1407125370 | Jessica Sarah Suhre | Nurse Practitioner | 1701 Lacey Street, Hospitalist Dept, Cape Girardeau, MO 63701 | 2011-12-22 |
1144559246 | Lisa M. Baker | Nurse Practitioner | 37 Doctors Park Ste 1, Cape Girardeau, MO 63703-4903 | 2009-12-18 |
1396072120 | Heather Miller | Nurse Practitioner | 2116 Megan Drive, Suite 102, Cape Girardeau, MO 63701 | 2009-11-16 |
1184857872 | Marie Nichole Wright | Nurse Practitioner | 817 S Mount Auburn Rd, Suite 100, Cape Girardeau, MO 63703-6383 | 2009-08-27 |
Find all providers in CAPE GIRARDEAU |
City | CAPE GIRARDEAU |
Zip Code | 63701 |
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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.