Healthcare Provider Details

I. General information

NPI: 1932298080
Provider Name (Legal Business Name): JILL L JENKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

PO BOX 34640
SEATTLE WA
98124-1640
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-5800
  • Fax: 509-473-4050
Mailing address:
  • Phone: 509-473-7005
  • Fax: 509-473-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberMD00027806
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00027806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: