Provider Demographics
NPI:1982171914
Name:JENKINS, KENNETH JAMES JR (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:JAMES
Other - Last Name:JENKINS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1631 11TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4332
Mailing Address - Country:US
Mailing Address - Phone:940-687-5000
Mailing Address - Fax:
Practice Address - Street 1:1631 11TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4332
Practice Address - Country:US
Practice Address - Phone:940-687-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13030363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant