Provider Demographics
NPI:1508985268
Name:JENKINS, KRISTEN (CRNP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PUBLIC SQ
Mailing Address - Street 2:STE 600
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-823-3040
Practice Address - Street 1:820 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1639
Practice Address - Country:US
Practice Address - Phone:570-595-4496
Practice Address - Fax:570-955-0139
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP0029299363LX0001X
PASP009299163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007678420043Medicaid
PA1025989180002Medicaid
PA1025989180004Medicaid
PA1007678420039Medicaid