MEDICARE: MRS. DARLENE G JENKINS CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CNP-000662	NM
2	363LF0000X	Family Nurse Practitioner	R32005	NM

General Provider Information

NPI Number	:	1023001591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE G JENKINS CFNP

Provider Business Mailing Address
First Line	:	PO BOX 349
Second Line	:
City	:	FT SUMNER
State	:	NM
Zip	:	88119-0843
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Provider Business Practice Location Address
First Line	:	546 NORTH 10TH ST.
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119
Country	:	US
Telephone Number	:	575-355-2444
Fax Number	:	575-253-4214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/30/2016

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