Individual ProviderConstance JacobNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1919 N Amidon Ave Ste 130, Wichita, KS 67203-2118(316) 660-7675(316) 660-7600PECOS EnrollmentBased on the most recent information from CMS, provider Constance Jacob is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1639729726Provider TypeIndividualFull NameJacob, ConstanceCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date9/19/2019Last Updated9/19/2019Contact InformationPractice LocationPractice Address1919 N Amidon Ave Ste 130, Wichita, KS 67203-2118Phone(316) 660-7675Fax(316) 941-5075Mailing LocationMailing Address271 W 3rd St N Ste 600, Wichita, KS 67202-1223Phone(316) 660-7600Fax(316) 941-5075Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense78963Kansas