Provider Demographics
NPI:1992388573
Name:JENKINS, CHRISTINA DAWN (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-9616
Mailing Address - Country:US
Mailing Address - Phone:910-265-1187
Mailing Address - Fax:
Practice Address - Street 1:301 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3496
Practice Address - Country:US
Practice Address - Phone:864-692-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAG02210040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner