Provider Demographics
NPI:1851076228
Name:JENKINS, KHRYSTI DANIELLE
Entity Type:Individual
Prefix:
First Name:KHRYSTI
Middle Name:DANIELLE
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 1:5224 SA JONES RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-9407
Mailing Address - Country:US
Mailing Address - Phone:785-249-2825
Mailing Address - Fax:
Practice Address - Street 1:5224 SA JONES RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-9407
Practice Address - Country:US
Practice Address - Phone:785-249-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239363372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion