Provider Demographics
NPI:1649465758
Name:JENKINS, KRISTEN C (LMP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 MAIN ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3464
Mailing Address - Country:US
Mailing Address - Phone:360-421-4097
Mailing Address - Fax:
Practice Address - Street 1:10024 MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3464
Practice Address - Country:US
Practice Address - Phone:425-485-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 00024312OtherWA MASSAGE PRACTITIONER LICENSE