Provider Demographics
NPI:1750996856
Name:JENKINS, PAULA JEAN
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 1/2 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1233
Mailing Address - Country:US
Mailing Address - Phone:681-758-1124
Mailing Address - Fax:
Practice Address - Street 1:212 1/2 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1233
Practice Address - Country:US
Practice Address - Phone:681-758-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide