Provider Demographics
NPI:1174618318
Name:MARKLEY, JENNIFER LYN (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:WINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST
Mailing Address - Street 2:BLDG G
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1834
Mailing Address - Country:US
Mailing Address - Phone:970-484-4871
Mailing Address - Fax:970-482-4927
Practice Address - Street 1:2001 S SHIELDS ST
Practice Address - Street 2:BLDG G
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1834
Practice Address - Country:US
Practice Address - Phone:970-484-4871
Practice Address - Fax:970-482-4927
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO37279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39678237Medicaid