Provider Demographics
NPI:1144086091
Name:JENKINS, KATHRYN MICHELE (CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MICHELE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 STALLION DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1943
Mailing Address - Country:US
Mailing Address - Phone:443-465-1144
Mailing Address - Fax:
Practice Address - Street 1:5009 HONEYGO CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9842
Practice Address - Country:US
Practice Address - Phone:443-910-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health