Provider Demographics
NPI:1285613893
Name:JENKINS, REBECCA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N FEDERAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3270
Mailing Address - Country:US
Mailing Address - Phone:641-494-2404
Mailing Address - Fax:
Practice Address - Street 1:5 N FEDERAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3270
Practice Address - Country:US
Practice Address - Phone:641-494-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3125625Medicaid
IA0265223Medicaid
IA54422OtherBCBS-GROUP NO.
IA54430OtherBCBS-INDIVIDUAL NO.
IA0265223Medicaid
IA54430OtherBCBS-INDIVIDUAL NO.
IA0265223Medicaid