Provider Demographics
NPI:1437393774
Name:JENKINS, JENNIFER LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
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 1:1040 MEDICAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5248
Mailing Address - Country:US
Mailing Address - Phone:252-633-1678
Mailing Address - Fax:252-633-1403
Practice Address - Street 1:1040 MEDICAL PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5248
Practice Address - Country:US
Practice Address - Phone:252-633-1678
Practice Address - Fax:252-633-1403
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102094363A00000X
NC102094NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC614FMedicare PIN
NCNCC614EMedicare PIN
NCNCC614DMedicare PIN