Provider Demographics
NPI:1114399284
Name:JENKINS, KRISTIE G (NP-C)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:G
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 S LAMAR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5354
Mailing Address - Country:US
Mailing Address - Phone:662-281-0112
Mailing Address - Fax:662-281-0943
Practice Address - Street 1:2908 S LAMAR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5354
Practice Address - Country:US
Practice Address - Phone:662-281-0112
Practice Address - Fax:662-281-0943
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901358363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology