Doctor Name: | TRACI LYN JENKINS |
NPI Number: | 1881927655 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN, FNP-C |
License Number: | 111066 |
Business Practice Address: | 100 Indian Hills Drive Macy, NE - 680390250 |
Business Phone Number: | 4028375381 |
Business Fax Number: | 4028375303 |
Mailing Address: | 100 Indian Hills Drive, MACY |
State: | NE |
Postal Code: | 680390250 |
Phone Number: | 4028375381 |
Fax Number: | 4028375303 |
NPI Enumeration Date: | 09/11/2009 |
NPI Last Update Date: | 09/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 111066 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |