Provider Demographics
NPI:1588691299
Name:JENKINS, JASON MICHAEL (MSE, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MSE, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4005
Mailing Address - Country:US
Mailing Address - Phone:940-552-6291
Mailing Address - Fax:940-552-0073
Practice Address - Street 1:4400 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4005
Practice Address - Country:US
Practice Address - Phone:940-552-6291
Practice Address - Fax:940-552-9229
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1662255A2300X
TXAT37972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT3797OtherSTATE LICENSE