Provider Demographics
NPI:1740284728
Name:JENKINS, LORI KAY (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4836
Mailing Address - Country:US
Mailing Address - Phone:731-435-3060
Mailing Address - Fax:833-941-2599
Practice Address - Street 1:137 TERRACE PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4836
Practice Address - Country:US
Practice Address - Phone:731-435-3060
Practice Address - Fax:833-941-2599
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN06197363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507251Medicaid