Healthcare Provider Details

I. General information

NPI: 1386772630
Provider Name (Legal Business Name): JOHN BRENT JENKINS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRENT JENKINS

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 BUHNE ST
EUREKA CA
95501-3207
US

IV. Provider business mailing address

670 9TH ST STE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-4038
  • Fax: 707-442-4039
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: