Provider Demographics
NPI:1235191107
Name:JENKINS, NAELA BERRY (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:NAELA
Middle Name:BERRY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:NAELA
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1430 DICKEN DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4417
Mailing Address - Country:US
Mailing Address - Phone:734-327-1051
Mailing Address - Fax:734-769-2075
Practice Address - Street 1:13699 E OLD US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-9664
Practice Address - Country:US
Practice Address - Phone:734-475-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177494363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics