Provider Demographics
NPI:1790401792
Name:JENKINS, RAVEN DAWN
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:DAWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 W VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26347-6446
Mailing Address - Country:US
Mailing Address - Phone:304-669-3711
Mailing Address - Fax:
Practice Address - Street 1:1038 W VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26347-6446
Practice Address - Country:US
Practice Address - Phone:304-669-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant