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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5464
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5464
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant