Provider Demographics
NPI:1558933184
Name:JENKINS, ALEXANDREA
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ACR 2703
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 ACR 2703
Practice Address - Street 2:
Practice Address - City:TENNESSEE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75861
Practice Address - Country:US
Practice Address - Phone:903-724-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine