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General NPI Number Information
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NPI Number | 1336439371
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Entity Type | Individual
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Provider Name | CARLA M JENKINS NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 1108 KINGWOOD DR
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City | AVON
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State | IN
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Zip | 46123-5500
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Country | US
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Telephone | 317-619-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 BUSH STREET
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City | RALEIGH
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State | NC
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Zip | 27609-7511
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Country | US
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Telephone | 919-876-7807
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Fax | 919-876-8823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71008420A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5005174
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License Number State | NC
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