Provider Demographics
NPI:1952723488
Name:JENKINS, KRYSTEN LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRYSTEN
Other - Middle Name:LYNN
Other - Last Name:THIESSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-427-4941
Mailing Address - Fax:405-951-8849
Practice Address - Street 1:3075 CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-4005
Practice Address - Country:US
Practice Address - Phone:405-427-4941
Practice Address - Fax:405-951-8849
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant