NPIMap

Ken Jenks, PA

Individual provider Active NPI Physician Assistant · Naturita, CO

NPI 1306901186 · NPPES record last updated Jun 13, 2013

Key facts

NPI
1306901186
Entity type
Individual (NPI type 1)
Primary specialty
Physician Assistant 363A00000X
License
PA 1103 (CO)
Practice address
421 W Adams
Naturita, CO 81422
Phone
(970) 865-2665
Fax
(970) 865-2674
NPI assigned
Dec 22, 2006
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 1103COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Radiology, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ken.jenks.1@17367.direct.athenahealth.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 1103 CO Yes

Addresses

Primary practice location

421 W Adams
Naturita, CO 81422

Mailing address

PO Box 340
Naturita, CO 81422-0340
Phone (970) 865-2665

Other identifiers

IdentifierTypeStateIssuer
840820573004OtherROCKY MTN HMO
2712462MedicaidCO
020250699OtherWORKERS COMP
JEJ63808OtherCOANTHEM BLUE CROSS

Other providers in Naturita, CO

All providers in Naturita, CO · Physician Assistant in Colorado

Sources for this page

Verify at the official NPI Registry.