NPI 1558947069

Jesse Lane Jenkins, IDC

Practitioner Independent Duty Corpsman Mountain City, TN

Practice location

Address: 1734 Cold Springs Rd, Mountain City, TN 37683-4040
Phone: (423) 440-9174

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1558947069
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Mar 2021
Record last updated: 23 Mar 2021

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.