Provider Demographics
NPI:1679327480
Name:JENKINS, KYLER (CNA)
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 NE 158TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7448
Mailing Address - Country:US
Mailing Address - Phone:360-952-1203
Mailing Address - Fax:
Practice Address - Street 1:3708 NE 158TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7448
Practice Address - Country:US
Practice Address - Phone:360-952-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide