Provider Demographics
NPI:1275184897
Name:JENKS, CAROL JO
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JO
Last Name:JENKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 JENKS RD
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-9391
Mailing Address - Country:US
Mailing Address - Phone:208-661-5627
Mailing Address - Fax:
Practice Address - Street 1:838 VAY RD
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-7768
Practice Address - Country:US
Practice Address - Phone:208-597-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider