Provider Demographics
NPI:1609865500
Name:JENKINSON, CAROL A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:JENKINSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N BLACKWELDER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1402
Mailing Address - Country:US
Mailing Address - Phone:405-208-6010
Mailing Address - Fax:405-208-6016
Practice Address - Street 1:2501 N BLACKWELDER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1402
Practice Address - Country:US
Practice Address - Phone:405-208-6010
Practice Address - Fax:405-208-6016
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0061574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200083080AMedicaid