Provider Demographics
NPI:1104401025
Name:JENKINS, DANIELLE R (CNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNP
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 414
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0414
Mailing Address - Country:US
Mailing Address - Phone:501-506-1587
Mailing Address - Fax:
Practice Address - Street 1:8 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9601
Practice Address - Country:US
Practice Address - Phone:501-506-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health