Provider Demographics
NPI:1528010881
Name:JENKINS, PATRICK L (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 HOWARDS CREEK MILL RD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-6711
Mailing Address - Country:US
Mailing Address - Phone:704-276-3629
Mailing Address - Fax:
Practice Address - Street 1:1161 HOWARDS CREEK MILL RD
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:NC
Practice Address - Zip Code:28168-6711
Practice Address - Country:US
Practice Address - Phone:704-276-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052236Medicaid
NC8052236Medicaid