Provider Demographics
NPI:1376900126
Name:JENKINS, MAURIAN (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:MAURIAN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WALL ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6754
Mailing Address - Country:US
Mailing Address - Phone:864-295-8714
Mailing Address - Fax:864-295-8764
Practice Address - Street 1:202 WALL ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6754
Practice Address - Country:US
Practice Address - Phone:864-295-8714
Practice Address - Fax:864-295-8764
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19876363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health