Individual
MRS. COURTNEY RENAE JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301
(304) 388-6261
(304) 388-3604
Mailing address
130 MOOREFIELD PLACE, SCOTT DEPOT, WV 25560
(304) 760-2182
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
57549
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
53978
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2602847000
—
WV
01
—
430078761
RR MEDICARE
—
Enumeration date
11/09/2006
Last updated
04/27/2015
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