Provider Demographics
NPI:1326687203
Name:JENKINS, CASEY RICHARD (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RICHARD
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PA-C
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 251420
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1420
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:870-464-1514
Practice Address - Street 1:303 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5317
Practice Address - Country:US
Practice Address - Phone:870-464-1515
Practice Address - Fax:870-464-1514
Is Sole Proprietor?:No
Enumeration Date:2019-12-25
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant