Provider Demographics
NPI:1083898332
Name:JENKS, WENDY ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:JENKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5109 EMMERYVILLE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6046
Mailing Address - Country:US
Mailing Address - Phone:214-695-0737
Mailing Address - Fax:
Practice Address - Street 1:5109 EMMERYVILLE LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6046
Practice Address - Country:US
Practice Address - Phone:214-695-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502104367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026858-05Medicaid
TXP01046402OtherMEDICARE RAILROAD
TX8416UCOtherBCBS FOR UAP KELLER ENDO, LLC
TXTXB147493OtherINDIVIDUAL PTAN FOR UAP KELLER ENDO, LLC
TXTXB147493OtherINDIVIDUAL PTAN FOR UAP KELLER ENDO, LLC
TX0026858-05Medicaid