Healthcare Provider Details

I. General information

NPI: 1720214398
Provider Name (Legal Business Name): JENNIFER LYNN JENKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JENNIFER LYNN MITCHELL

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 05/05/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

118 NORTHPORT AVE
BELFAST ME
04915-6072
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-4123
  • Fax: 207-338-6820
Mailing address:
  • Phone: 207-505-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003960
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1869
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: