Provider Demographics
NPI:1538586144
Name:CONNIE JENKINS, M.D., INC
Entity type:Organization
Organization Name:CONNIE JENKINS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-321-6253
Mailing Address - Street 1:5 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1210
Mailing Address - Country:US
Mailing Address - Phone:614-321-6253
Mailing Address - Fax:
Practice Address - Street 1:5 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1210
Practice Address - Country:US
Practice Address - Phone:614-321-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH692152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty