Provider Demographics
NPI:1417921883
Name:JENKINS, PATRICK F JR (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HOSPITAL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2872
Mailing Address - Country:US
Mailing Address - Phone:606-451-2650
Mailing Address - Fax:606-451-2641
Practice Address - Street 1:350 HOSPITAL WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2872
Practice Address - Country:US
Practice Address - Phone:606-451-2650
Practice Address - Fax:606-451-2641
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C92453OtherCUMBERLAND HEALTHCARE
KY64266109Medicaid
000000054074OtherANTHEM
5686144OtherAETNA
5125850OtherCCN
0088056OtherCHA
KY64266109Medicaid
KY64266109Medicaid
C92453OtherCUMBERLAND HEALTHCARE