Provider Demographics
NPI:1730357807
Name:JENKINS, MARTHA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 AIRLINE HWY
Mailing Address - Street 2:LSU UNIT
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2408
Mailing Address - Country:US
Mailing Address - Phone:225-358-1065
Mailing Address - Fax:225-358-1076
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:LSU UNIT
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2408
Practice Address - Country:US
Practice Address - Phone:225-358-1065
Practice Address - Fax:225-358-1076
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA .A10217.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant