Provider Demographics
NPI:1316447139
Name:JENKINS, JILL REA (LVN)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:REA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:202 W HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1118
Mailing Address - Country:US
Mailing Address - Phone:254-218-2877
Mailing Address - Fax:
Practice Address - Street 1:20606 N IH 35
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1812
Practice Address - Country:US
Practice Address - Phone:469-219-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143826164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty