Provider Demographics
NPI:1215768544
Name:JENKINS, BRIAN KEITH (RECOVERY SPECIALIST)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:JENKINS
Suffix:
Gender:M
Credentials:RECOVERY SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 ODLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2742
Mailing Address - Country:US
Mailing Address - Phone:937-520-3562
Mailing Address - Fax:
Practice Address - Street 1:520 ODLIN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2742
Practice Address - Country:US
Practice Address - Phone:937-520-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005350175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty