Healthcare Provider Details

I. General information

NPI: 1477556215
Provider Name (Legal Business Name): PAUL W JENKINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/17/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD STE 50
KANSAS CITY MO
64111-3201
US

IV. Provider business mailing address

PO BOX 7411931
CHICAGO IL
60674-1931
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-3312
  • Fax: 816-531-9862
Mailing address:
  • Phone: 816-931-3312
  • Fax: 816-531-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4138
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50001399
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number114597
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: