Provider Demographics
NPI:1972943728
Name:JENKS, RYAN (JD, BS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:JENKS
Suffix:
Gender:M
Credentials:JD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9196 W EMERALD ST STE 135
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8004
Mailing Address - Country:US
Mailing Address - Phone:208-323-4400
Mailing Address - Fax:
Practice Address - Street 1:9196 W EMERALD ST STE 135
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8004
Practice Address - Country:US
Practice Address - Phone:208-323-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator