Provider Demographics
NPI:1902512874
Name:JENKINS, KELLEY MORGAN (RN, SRNA)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MORGAN
Last Name:JENKINS
Suffix:
Gender:
Credentials:RN, SRNA
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9597 KIMBERLY LYNN CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-7311
Mailing Address - Country:US
Mailing Address - Phone:757-262-9562
Mailing Address - Fax:
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5023
Practice Address - Country:US
Practice Address - Phone:757-262-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001250651163W00000X
VA0024192503367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse