Individual
MR. PHILIP JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2301 INDIAN WELLS RD, ALAMOGORDO, NM 88310-4611
(505) 437-0890
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-2139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R16286
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158942800
DOL
NM
01
—
430028477
IND RR MCARE
NM
05
—
92395
—
NM
01
—
NM006064
IND NM BCBS
NM
Enumeration date
10/31/2006
Last updated
11/11/2016
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