Provider Demographics
NPI:1477165264
Name:JENKINS, ALISA DAWN
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:DAWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:DAWN
Other - Last Name:GALLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1017 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1009
Mailing Address - Country:US
Mailing Address - Phone:304-691-9865
Mailing Address - Fax:
Practice Address - Street 1:1017 28TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1009
Practice Address - Country:US
Practice Address - Phone:304-691-9865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant