Provider Demographics
NPI:1295457471
Name:JENKINS, MATTHEW D (APRN-RX, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:JENKINS
Suffix:
Gender:M
Credentials:APRN-RX, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 AIKEPA ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8131
Mailing Address - Country:US
Mailing Address - Phone:808-855-5775
Mailing Address - Fax:
Practice Address - Street 1:4210 HANAHAO PL STE 202
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9036
Practice Address - Country:US
Practice Address - Phone:808-855-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty