Provider Demographics
NPI:1093404451
Name:JENKINS, HOLLY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JO
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-9535
Mailing Address - Country:US
Mailing Address - Phone:501-993-0386
Mailing Address - Fax:
Practice Address - Street 1:2510 CRYSTAL LAKE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-9535
Practice Address - Country:US
Practice Address - Phone:501-993-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR083534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse