Healthcare Provider Details

I. General information

NPI: 1649133687
Provider Name (Legal Business Name): ANITA FAYE JENKINS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 NEHALEM BOULAVARD
WHEELER OR
97147
US

IV. Provider business mailing address

3614 FOREST HILL RD
JACKSON MS
39212-4401
US

V. Phone/Fax

Practice location:
  • Phone: 800-368-5182
  • Fax:
Mailing address:
  • Phone: 601-842-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907922
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10063317
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: