Provider Demographics
NPI:1881383248
Name:JENKINS, KRISTOPHER B (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:B
Last Name:JENKINS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 S 100 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6603
Mailing Address - Country:US
Mailing Address - Phone:801-864-1405
Mailing Address - Fax:
Practice Address - Street 1:3385 S 100 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6603
Practice Address - Country:US
Practice Address - Phone:801-864-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10480054-4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine