Provider Demographics
NPI:1841288040
Name:JENKINS, IRMA N (CRNA)
Entity type:Individual
Prefix:MS
First Name:IRMA
Middle Name:N
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:6286 BRIARCREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4023
Mailing Address - Country:US
Mailing Address - Phone:901-747-4624
Mailing Address - Fax:901-261-2542
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0513
Practice Address - Fax:870-261-0126
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00494367500000X
ARR015393163W00000X
ARP000113164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59463OtherARKANSAS BLUE CROSS BLUE SHIELD
ARP00299197OtherRAILROAD MEDICARE
AR135871701Medicaid
AR1841288040OtherQUALCHOICE OF ARKANSAS
AR1841288040OtherUNITED HEALTHCARE
AR1841288040OtherTRICARE - SOUTH REGION
AR1841288040OtherBAPTIST HEALTH SERVICES GROUP, INC.
AR135871701Medicaid