Provider Demographics
NPI:1770823809
Name:JENKINS, PERRY SAMUEL JR (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:SAMUEL
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KALI CT
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8425
Mailing Address - Country:US
Mailing Address - Phone:910-467-6865
Mailing Address - Fax:
Practice Address - Street 1:110 BRANCHWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5900
Practice Address - Country:US
Practice Address - Phone:910-938-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health