Provider Demographics
NPI:1659668663
Name:JENKINS, CHRISTY LEEANN (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEEANN
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 1:4343 W BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0532
Mailing Address - Country:US
Mailing Address - Phone:573-303-6044
Mailing Address - Fax:
Practice Address - Street 1:4343 W BETHANY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0532
Practice Address - Country:US
Practice Address - Phone:573-303-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036009164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse