Provider Demographics
NPI:1033153796
Name:JENKINS, SUZANNE (DPM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:904 CORSICANA HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2928
Mailing Address - Country:US
Mailing Address - Phone:254-582-9300
Mailing Address - Fax:254-582-9302
Practice Address - Street 1:904 CORSICANA HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2928
Practice Address - Country:US
Practice Address - Phone:254-582-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1774213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W6080OtherBCBS
TX186392001Medicaid
TXV11921Medicare UPIN
TX6054290001Medicare NSC
TX8F4682Medicare PIN
TX186392001OtherMEDICAID INDIVIDUAL NUMBE