Provider Demographics
NPI:1629847132
Name:JENKINS, AMY ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-3367
Mailing Address - Fax:
Practice Address - Street 1:502 RICHIE RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3309
Practice Address - Country:US
Practice Address - Phone:501-941-0940
Practice Address - Fax:501-941-1875
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR229536363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program