Provider Demographics
NPI:1104927334
Name:JENKINS, DEBORAH (FNP,WHNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GUESS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4155
Mailing Address - Country:US
Mailing Address - Phone:864-233-2744
Mailing Address - Fax:
Practice Address - Street 1:401 GUESS STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4155
Practice Address - Country:US
Practice Address - Phone:864-233-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1012363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare ID - Type UnspecifiedMEDICARE
SC566242Medicare UPIN