NPI 1104246719

Kenyatta Ameer Jenkins, ATC

Practitioner Athletic Trainer Bloomington, IL

Practice location

Address: 808 S Eldorado Rd STE 2w, Bloomington, IL 61704-6034
Phone: (309) 661-0232
Mailing address: 59 Fedor Cir, Bloomington, IL 61705-5108

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 096003570 (IL)

Other Specialist/Technologist providers in Illinois →

Registry record

NPI: 1104246719
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Apr 2014
Record last updated: 22 Apr 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.