JACOB LOUIS MUCKERMAN


Address: 1723 Broadway St, Suite 410, Cape Girardeau, MO 63701-4566
Phone: 5733391957

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
2012027450 MO Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MO MEDICAL LICENSE 2012027450 01

Office Location

Street Address 1723 BROADWAY ST
SUITE 410
City CAPE GIRARDEAU
State MO
Zip Code 63701-4566

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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
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Competitor

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City CAPE GIRARDEAU
Zip Code 63701

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Dataset Information

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.

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