Jacobson, Alice Kelley

Jacobson, Alice Kelley is an sole proprietor health care provider with primary practice located at 244 Western Ave Ste 100 , South Portland ME 04106. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Jacobson, Alice Kelley can be contacted via phone (207) 775-3446.

Contact Information

Primary practice address
244 Western Ave Ste 100 South Portland ME 04106
Phone: (207) 775-3446
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1558814483
LBN Legal business name Jacobson, Alice Kelley
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 27th, 2016
Last updated Nov 15th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558814483 NPPES
Maine MEDICAID 1679687594

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