Provider Demographics
NPI:1639770712
Name:JENKINS, HANNAH LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 HIGHWAY 9 E STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8164
Mailing Address - Country:US
Mailing Address - Phone:803-795-2863
Mailing Address - Fax:
Practice Address - Street 1:100 N SUMTER ST STE 200
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4975
Practice Address - Country:US
Practice Address - Phone:803-774-7621
Practice Address - Fax:803-774-1791
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4466PAMedicaid