Provider Demographics
NPI:1629733357
Name:JENKINS, HEATHER (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BUCK CREEK VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-5937
Mailing Address - Country:US
Mailing Address - Phone:812-972-4347
Mailing Address - Fax:
Practice Address - Street 1:871 PACER DR NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2145
Practice Address - Country:US
Practice Address - Phone:812-738-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27061756A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse