Provider Demographics
NPI:1376555979
Name:JENKINS, CICELY W (RN,BC)
Entity Type:Individual
Prefix:MRS
First Name:CICELY
Middle Name:W
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 CEDARIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4301
Mailing Address - Country:US
Mailing Address - Phone:803-787-1513
Mailing Address - Fax:
Practice Address - Street 1:THOMSON STUDENT HEALTH CTR
Practice Address - Street 2:UNIVERSITY OF SOUTH CAROLINA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-3669
Practice Address - Fax:803-777-0126
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20552163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator