Provider Demographics
NPI:1649619313
Name:JENKINS, KELLY BROWN (CPM, LM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BROWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:BLUEMONT
Mailing Address - State:VA
Mailing Address - Zip Code:20135-4854
Mailing Address - Country:US
Mailing Address - Phone:703-727-3053
Mailing Address - Fax:
Practice Address - Street 1:96 LOCUST LN
Practice Address - Street 2:
Practice Address - City:BLUEMONT
Practice Address - State:VA
Practice Address - Zip Code:20135-4854
Practice Address - Country:US
Practice Address - Phone:703-727-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000086176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife