MEDICARE: KENDRA DALE JENKINS NP

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	775999	TX

General Provider Information

NPI Number	:	1811336928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA DALE JENKINS NP

Provider Business Mailing Address
First Line	:	4914 HIGH MEADOW DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2433
Country	:	US
Telephone Number	:	361-767-9963
Fax Number	:

Provider Business Practice Location Address
First Line	:	14041 NORTHWEST BLVD
Second Line	:	STE 1
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5137
Country	:	US
Telephone Number	:	361-767-9963
Fax Number	:

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	01/21/2015

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