Provider Demographics
NPI:1922745579
Name:JENKINS, ABAGAEL R
Entity Type:Individual
Prefix:
First Name:ABAGAEL
Middle Name:R
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 1:530 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1235
Mailing Address - Country:US
Mailing Address - Phone:317-403-8345
Mailing Address - Fax:
Practice Address - Street 1:10801 N MICHIGAN RD STE 240
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7845
Practice Address - Country:US
Practice Address - Phone:317-732-9550
Practice Address - Fax:317-203-0929
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28232523A163W00000X
IN71012910A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse