Provider Demographics
NPI:1538160379
Name:JENKINS-MCCORD, TERESA L (CANP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:JENKINS-MCCORD
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HOMESTEAD RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1524
Mailing Address - Country:US
Mailing Address - Phone:505-237-2574
Mailing Address - Fax:505-237-3632
Practice Address - Street 1:2509 VIRGINIA ST NE
Practice Address - Street 2:STE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-237-2574
Practice Address - Fax:505-237-3632
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR37512207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS18856Medicare UPIN