Provider Demographics
NPI:1407371388
Name:JENKINS, DEBRA LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MCVITTY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7405
Mailing Address - Country:US
Mailing Address - Phone:1540-392-7777
Mailing Address - Fax:
Practice Address - Street 1:1905 MCVITTY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7405
Practice Address - Country:US
Practice Address - Phone:540-392-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner