Provider Demographics
NPI:1255530432
Name:JENKINS, NATASHA K (OD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:K
Last Name:JENKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4665
Mailing Address - Country:US
Mailing Address - Phone:308-635-1234
Mailing Address - Fax:308-635-7505
Practice Address - Street 1:3726 AVENUE D
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4665
Practice Address - Country:US
Practice Address - Phone:308-635-1234
Practice Address - Fax:308-635-7505
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315568OtherBCBS WYOMING
WY315568OtherBCBS WYOMING
WY0312350002Medicare NSC