Provider Demographics
NPI:1326152695
Name:JENKINS, MICHELLE R (MS, APRN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 BULL RIDER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8000
Mailing Address - Country:US
Mailing Address - Phone:775-622-8950
Mailing Address - Fax:
Practice Address - Street 1:699 CHURCH ST NE STE 235
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1132
Practice Address - Country:US
Practice Address - Phone:770-590-4177
Practice Address - Fax:770-590-4187
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR108642363LW0102X
NVAPN001144363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ46980Medicare UPIN
GA50BBJLNMedicare ID - Type Unspecified