Provider Demographics
NPI:1699072900
Name:JENKINS, CHELSEA (PA-C, MHS)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA-C, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:VELMA
Mailing Address - State:OK
Mailing Address - Zip Code:73491-0894
Mailing Address - Country:US
Mailing Address - Phone:405-819-5969
Mailing Address - Fax:
Practice Address - Street 1:2115 DUNCAN REGIONAL LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1570
Practice Address - Country:US
Practice Address - Phone:580-470-9800
Practice Address - Fax:580-470-9802
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant