Provider Demographics
NPI:1083736284
Name:JENKINS, JUDITH ARLENE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ARLENE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 STIMMEL RD
Mailing Address - Street 2:2A
Mailing Address - City:COLUMBUA
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2931
Mailing Address - Country:US
Mailing Address - Phone:614-308-0770
Mailing Address - Fax:
Practice Address - Street 1:6100 CHANNINGWAY BLVD
Practice Address - Street 2:CARE STAR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-751-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH373250400893374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide