Provider Demographics
NPI:1194034009
Name:JENKINS, JENNIFER ODEAN (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ODEAN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 SMITH DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-8914
Mailing Address - Country:US
Mailing Address - Phone:812-746-7728
Mailing Address - Fax:
Practice Address - Street 1:6301 SMITH DIAMOND RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-8914
Practice Address - Country:US
Practice Address - Phone:812-746-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011742A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist