Provider Demographics
NPI:1114128972
Name:JENKINS, NICHOLAS PAIGE (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PAIGE
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12851 BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7445
Mailing Address - Country:US
Mailing Address - Phone:463-220-3486
Mailing Address - Fax:
Practice Address - Street 1:12851 BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7445
Practice Address - Country:US
Practice Address - Phone:463-220-3486
Practice Address - Fax:317-449-8632
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066864A208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200953650Medicaid
IN230940008Medicare PIN