| Doctor Name: | MRS. WILLETTA ROZENA JACOBS |
| NPI Number: | 1033326590 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | R0073641 |
| Business Practice Address: | 4411 W Gore Blvd Suite A2 Lawton, OK - 735055977 |
| Business Phone Number: | 5803550575 |
| Business Fax Number: | 5802481725 |
| Mailing Address: | Po Box 785, LAWTON |
| State: | OK |
| Postal Code: | 735020785 |
| Phone Number: | 5803579984 |
| Fax Number: | 5803573277 |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 03/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R0073641 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |