Mary Kaye Jenks, APRN-NP-C
Individual provider Active NPI Family Nurse Practitioner · Oasis, ID
NPI 1194155598 · NPPES record last updated Nov 21, 2013
Key facts
- NPI
- 1194155598
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP1347A (ID)
- Practice address
- 20806 Ditto Creek Rd
Oasis, ID 83647-5034 - Phone
- (208) 796-2119
- NPI assigned
- Nov 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160115000523 | ID | Practitioner - Nurse Practitioner | 2466755046 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP1347A | ID | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients |
Locations
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
1226 W River St
Boise, ID 83702
Phone (208) 331-1155
130 E Boise Ave
Boise, ID 83706
Phone (208) 345-4066
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
840 N 4th E
Mountain Home, ID 83647
Phone (208) 587-1850
465 McKenna Dr
Mtn Home, ID 83647
Phone (208) 587-9703
895 N 6th E
Mtn Home, ID 83647
Phone (208) 580-2661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP1347A | ID | Yes |
Addresses
Primary practice location
20806 Ditto Creek Rd
Oasis, ID 83647-5034
Mailing address
20806 Ditto Creek Rd
Oasis, ID 83647-5034
Phone (208) 796-2119
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.