Provider Demographics
NPI:1477799369
Name:JENKS, ERICA LYN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYN
Last Name:JENKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KINGS CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-5064
Mailing Address - Country:US
Mailing Address - Phone:314-775-5125
Mailing Address - Fax:
Practice Address - Street 1:660A S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2235
Practice Address - Country:US
Practice Address - Phone:636-931-3800
Practice Address - Fax:636-931-3911
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011040880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011040880OtherNURSE PRACTIIONER LICENSE
IL209007408OtherCERTIFIED NURSE PRACTITIONER