License holder summary

KaNissha M. Jacobs is a Radiology Provisional Permit licensed to practice in Indiana. The address on file for KaNissha M. Jacobs is South Bend IN 46635-2012. This licensed professional license is not current. The license was granted 10/03/2007 and expired on 04/03/2008.

Indiana

Professional Licensing Agency

KaNissha M. Jacobs
Radiology Provisional Permit
License number
XP500822
Date granted
10/03/2007
Date expires
04/03/2008
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
South Bend IN 46635-2012
indianalicensing.org
ID 8495429
LAST UPDATED 2024-04-19 02:38:59 UTC

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