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General NPI Number Information
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NPI Number | 1447564992
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Entity Type | Individual
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Provider Name | JEFFREY K JENKINS CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 1211 MAIN ST
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City | HARTFORD
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State | KY
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Zip | 42347-1619
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Country | US
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Telephone | 270-298-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 103 RENFROW VALLEY RD
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City | MORGANTOWN
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State | KY
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Zip | 42261-9350
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Country | US
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Telephone | 270-526-5956
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 084055
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License Number State | KY
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