Healthcare Provider Details

I. General information

NPI: 1013438183
Provider Name (Legal Business Name): SETH MICHAEL JENKS DNP APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E PRIMROSE ST STE E
SPRINGFIELD MO
65807-5233
US

IV. Provider business mailing address

2055 S FREMONT AVE
SPRINGFIELD MO
65804-2206
US

V. Phone/Fax

Practice location:
  • Phone: 417-888-0167
  • Fax: 417-888-0189
Mailing address:
  • Phone: 417-820-2468
  • Fax: 417-820-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017022237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: