Healthcare Provider Details

I. General information

NPI: 1417921883
Provider Name (Legal Business Name): PATRICK F JENKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL WAY SUITE 100
SOMERSET KY
42503-2872
US

IV. Provider business mailing address

350 HOSPITAL WAY SUITE 100
SOMERSET KY
42503-2872
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-2650
  • Fax: 606-451-2641
Mailing address:
  • Phone: 606-451-2650
  • Fax: 606-451-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26610
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: