Individual
SHANNON JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2860 CHANNING WAY, SUITE 100, IDAHO FALLS, ID 83404-7531
(208) 535-4575
(208) 535-4569
Mailing address
2860 CHANNING WAY STE 100, IDAHO FALLS, ID 83404-7531
(208) 535-4575
(208) 535-4569
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
3863
AZ
2080N0001X
Neonatal-Perinatal Medicine Physician
C4692
KY
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
O0424
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0117377
—
MT
05
—
121542600
—
ID
05
—
121542600
—
WY
05
—
1285786046
—
WY
Enumeration date
02/17/2006
Last updated
12/30/2025
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