MEDICARE: MR. PAUL W JENKINS PA-C

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	363A00000X	Physician Assistant	4138	SC
2	363AS0400X	Surgical Physician Assistant	50001399	OH
3	363AS0400X	Surgical Physician Assistant	114597	MO

General Provider Information

NPI Number	:	1477556215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL W JENKINS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7411931
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-1931
Country	:	US
Telephone Number	:	816-931-3312
Fax Number	:	816-531-9862

Provider Business Practice Location Address
First Line	:	4330 WORNALL RD STE 50
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3201
Country	:	US
Telephone Number	:	816-931-3312
Fax Number	:	816-531-9862

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/17/2025

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