Provider Demographics
NPI:1679874788
Name:JENKINS, LATONYA BOND (RN)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:BOND
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1712
Mailing Address - Country:US
Mailing Address - Phone:252-793-1619
Mailing Address - Fax:252-793-1644
Practice Address - Street 1:210 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1712
Practice Address - Country:US
Practice Address - Phone:252-793-1619
Practice Address - Fax:252-793-1644
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC181OtherEMPLOYEE ID NUMBER