Provider Demographics
NPI:1063997062
Name:JENKINSON, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:JENKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32839
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2839
Mailing Address - Country:US
Mailing Address - Phone:907-789-7610
Mailing Address - Fax:
Practice Address - Street 1:5929 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9710
Practice Address - Country:US
Practice Address - Phone:925-216-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator