Provider Demographics
NPI:1144451568
Name:JENKINS, DAWN ROSA (DNP, PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ROSA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP-C
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:ROSA
Other - Last Name:JENKINSMCNAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:22 FALCONRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7192
Mailing Address - Country:US
Mailing Address - Phone:910-728-7021
Mailing Address - Fax:
Practice Address - Street 1:1706 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2240
Practice Address - Country:US
Practice Address - Phone:919-734-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004444363LF0000X
NC178971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF0609154OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION
NC1144451568Medicaid
MDAC004495OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER LICENSE
NC2021184015OtherAMERICAN NURSES CREDENTIALING CENTER
NC1144451568OtherBCBSNC
MDT2336OtherMARYLAND CDS
MDT2336OtherMARYLAND CDS