Provider Demographics
NPI:1013642305
Name:JENKINSON, CAMILLE LOYE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:LOYE
Last Name:JENKINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:LOYE
Other - Last Name:HUNSAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18307 FLETCHERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6158
Mailing Address - Country:US
Mailing Address - Phone:385-539-7255
Mailing Address - Fax:
Practice Address - Street 1:1911 FALLS VALLEY DR STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2496
Practice Address - Country:US
Practice Address - Phone:919-249-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant