Provider Demographics
NPI:1104043082
Name:JENKINS, IVY LEVERETT (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:IVY
Middle Name:LEVERETT
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:D
Other - Last Name:LEVERETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 29TH AVE N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1401
Mailing Address - Country:US
Mailing Address - Phone:615-327-4304
Mailing Address - Fax:615-327-5434
Practice Address - Street 1:110 29TH AVE N
Practice Address - Street 2:SUITE 301
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1401
Practice Address - Country:US
Practice Address - Phone:615-327-4304
Practice Address - Fax:615-327-5435
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12405367500000X
TNRN118124163W00000X
VA0024168102163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I433057Medicare PIN
VAQ36306AMedicare PIN