Individual
SUSAN D JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 251-1200
Mailing address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 251-1200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
108151
MO
163W00000X
Registered Nurse
1354266031
KS
367500000X
Certified Registered Nurse Anesthetist
2010035242
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
4355524
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200400270A
—
KS
01
—
P00380549
RR MEDICARE
KS
Enumeration date
08/17/2006
Last updated
09/02/2022
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