Provider Demographics
NPI:1861674681
Name:JENKINS, BETHANEY BUDDILYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANEY
Middle Name:BUDDILYN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4102
Mailing Address - Country:US
Mailing Address - Phone:918-225-0616
Mailing Address - Fax:918-225-3740
Practice Address - Street 1:1030 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4102
Practice Address - Country:US
Practice Address - Phone:918-225-0616
Practice Address - Fax:918-225-3740
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200127530AMedicaid
OKOK100072Medicare PIN