Provider Demographics
NPI:1780728162
Name:JENKINS, HORACE JOSEPH (CRNA)
Entity type:Individual
Prefix:MR
First Name:HORACE
Middle Name:JOSEPH
Last Name:JENKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 1200 AVE
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:KS
Mailing Address - Zip Code:67451-9405
Mailing Address - Country:US
Mailing Address - Phone:785-257-3374
Mailing Address - Fax:
Practice Address - Street 1:1924 1200 AVE
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:KS
Practice Address - Zip Code:67451-9405
Practice Address - Country:US
Practice Address - Phone:785-257-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered