Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Warren Kooistra Devries

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1811658131

Jacob Warren Kooistra Devries is a Student in an Organized Health Care Education/Training Program in Bloomington, Indiana. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

701 E 17th St
Bloomington, IN 47408-1578
Phone: (812) 856-4465
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1811658131
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 8, 2022
Last updated in NPPESJanuary 8, 2022
Certification dateJanuary 8, 2022
Mailing address4425 Hickory Grove Blvd, Greenwood, IN 46143-7445

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