Provider Demographics
NPI:1841244720
Name:JENKINS, WILLYN TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLYN
Middle Name:TAYLOR
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5180 PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3530
Mailing Address - Country:US
Mailing Address - Phone:901-542-0600
Mailing Address - Fax:901-542-9411
Practice Address - Street 1:5180 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3530
Practice Address - Country:US
Practice Address - Phone:901-542-0600
Practice Address - Fax:901-542-9411
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000019606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC73528Medicare UPIN
TN3068964Medicare ID - Type Unspecified