Active NPI
Mary Jenkins, PA
- Medical Physician Assistant
- Yakima, WA
National Provider Identifier
1861586190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10000693
- Practice address
- 602 E Nob Hill Blvd
Yakima, WA 98901-3534 - Phone
- (509) 248-3334
- Fax
- (509) 453-6144
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10000693 | WA | Primary |
Addresses
Primary practice location
602 E Nob Hill Blvd
Yakima, WA 98901-3534
Mailing address
PO Box 190
Toppenish, WA 98948-0190
Phone (509) 865-6175
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8100935 | Other | WA | CHPW |
| 8100935 | Medicaid | WA | |
| 23807 | Other | GROUP HEALTH | |
| JE6901 | Other | WA | REGENCE |
| 68101 | Other | WA | L & I |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10000693 | WA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861586190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 190",
"city": "TOPPENISH",
"state": "WA",
"postal_code": "989480190",
"telephone_number": "509-865-6175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 E NOB HILL BLVD",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989013534",
"telephone_number": "509-248-3334",
"fax_number": "509-453-6144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "MARY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10000693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHPW",
"identifier": "8100935",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8100935",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH",
"identifier": "23807",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "JE6901",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "68101",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.