Healthcare Provider Details

I. General information

NPI: 1396001129
Provider Name (Legal Business Name): KEVIN BRICE JENKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 KING AVE
COLUMBUS OH
43201-2632
US

IV. Provider business mailing address

1256 PRUSSIA RD
WAVERLY OH
45690-7501
US

V. Phone/Fax

Practice location:
  • Phone: 614-525-5290
  • Fax:
Mailing address:
  • Phone: 423-767-8447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number53688
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: