Provider Demographics
NPI:1194699454
Name:JENKINS, TIMOTHY RAY (BS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:JENKINS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:4844 CALLE BELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7066
Mailing Address - Country:US
Mailing Address - Phone:575-382-5973
Mailing Address - Fax:575-541-3635
Practice Address - Street 1:4844 CALLE BELLA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7066
Practice Address - Country:US
Practice Address - Phone:575-382-5973
Practice Address - Fax:575-541-3635
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program