Provider Demographics
NPI:1083714349
Name:JENKINS, KATHLEEN THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:THERESA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637801
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7801
Mailing Address - Country:US
Mailing Address - Phone:941-753-7585
Mailing Address - Fax:941-758-2153
Practice Address - Street 1:4319 20TH ST W
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5000
Practice Address - Country:US
Practice Address - Phone:941-753-7585
Practice Address - Fax:941-758-2153
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00439042083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680451-00Medicaid
96309-4Medicare ID - Type Unspecified
FL680451-00Medicaid