Individual
JORDAN JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
411 CENTRAL METHODIST SQ STE 1, FAYETTE, MO 65248-1198
(660) 248-6978
Mailing address
106 S MULBERRY ST, FAYETTE, MO 65248-1316
(816) 824-7136
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2020026480
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020026480
ATHLETIC TRAINER
MO
Enumeration date
01/11/2021
Last updated
01/11/2021
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