Provider Demographics
NPI:1487391108
Name:JENKINS, KAITLYN ADELLE (CNA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ADELLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:ND
Mailing Address - Zip Code:58064-0064
Mailing Address - Country:US
Mailing Address - Phone:701-404-3768
Mailing Address - Fax:
Practice Address - Street 1:304 JB JAMES AVE
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:ND
Practice Address - Zip Code:58064-7705
Practice Address - Country:US
Practice Address - Phone:302-864-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND816713747P1801X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant