Provider Demographics
NPI:1871550491
Name:JENKS, DEBORAH SUE (DNP, PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUE
Last Name:JENKS
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14057 US HIGHWAY 17 STE 200
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3793
Mailing Address - Country:US
Mailing Address - Phone:910-821-1418
Mailing Address - Fax:866-860-0997
Practice Address - Street 1:14057 US HIGHWAY 17 STE 200
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3793
Practice Address - Country:US
Practice Address - Phone:910-821-1418
Practice Address - Fax:866-860-0997
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009986363LF0000X, 363LP0808X, 363L00000X, 363LP0808X
NCS4461101YM0800X
NC500986363LF0000X
VA0024175505363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5009986OtherNORTH CAROLINA BOARD OF NURSING
VA0024175505OtherVIRGINA BOARD OF NURSING
NC0024175505OtherNURSE PRACTITIONER
NC4461SOtherNORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS
NC6102245Medicaid