Provider Demographics
NPI:1578589537
Name:JENKINS, LOUISE (APN)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SOURWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-4769
Mailing Address - Country:US
Mailing Address - Phone:423-265-2271
Mailing Address - Fax:423-785-3454
Practice Address - Street 1:100 MOCCASIN BEND RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4415
Practice Address - Country:US
Practice Address - Phone:423-265-2271
Practice Address - Fax:423-785-3454
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN37881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91021Medicare UPIN
TN44-4002Medicare Oscar/Certification
TN3282227Medicare ID - Type UnspecifiedMEDICARE B