Provider Demographics
NPI:1043545213
Name:JENKINS, DAMARA L (CNM)
Entity Type:Individual
Prefix:
First Name:DAMARA
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-337-4487
Mailing Address - Fax:
Practice Address - Street 1:450 S WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-337-4487
Practice Address - Fax:717-461-7149
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003059A367A00000X
KY13147367A00000X
PAMW010701367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201047780AMedicaid