Provider Demographics
NPI:1265283642
Name:JENKINS, ERICK W (NP)
Entity type:Individual
Prefix:MR
First Name:ERICK
Middle Name:W
Last Name:JENKINS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2302
Mailing Address - Country:US
Mailing Address - Phone:936-240-9804
Mailing Address - Fax:
Practice Address - Street 1:510 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2302
Practice Address - Country:US
Practice Address - Phone:936-240-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831820163WE0003X
TX1172155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency