Provider Demographics
NPI:1114581287
Name:JENKINS, TERISA M (FNP)
Entity Type:Individual
Prefix:
First Name:TERISA
Middle Name:M
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:TERISA
Other - Middle Name:M
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4715 W US 40 HWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-0951
Mailing Address - Country:US
Mailing Address - Phone:816-229-9118
Mailing Address - Fax:816-463-7107
Practice Address - Street 1:4715 W US 40 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-0951
Practice Address - Country:US
Practice Address - Phone:816-229-9118
Practice Address - Fax:816-463-7107
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily