Healthcare Provider Details

I. General information

NPI: 1114128972
Provider Name (Legal Business Name): NICHOLAS PAIGE JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 BROAD ST STE 100
CARMEL IN
46032-7445
US

IV. Provider business mailing address

12851 BROAD ST STE 100
CARMEL IN
46032-7445
US

V. Phone/Fax

Practice location:
  • Phone: 463-220-3486
  • Fax: 317-449-8632
Mailing address:
  • Phone: 463-220-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01066864A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01066864A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: