Provider Demographics
NPI:1912102666
Name:JENKERSON, SUE ANNE (RNC, FNP)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANNE
Last Name:JENKERSON
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4562
Mailing Address - Country:US
Mailing Address - Phone:907-274-2926
Mailing Address - Fax:907-562-7802
Practice Address - Street 1:3601 C ST
Practice Address - Street 2:SUITE 540
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5924
Practice Address - Country:US
Practice Address - Phone:907-269-8000
Practice Address - Fax:907-562-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKU 145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily