KIMBERLY JO JENKO (NPI# 1154952497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154952497 |
| Entity Type | Individual |
| Full Name | KIMBERLY JO JENKO |
| Credential | PA |
| Practice Address |
5601 Loch Raven Blvd Baltimore MD 21239-2945 |
| Mailing Address |
434 Lewis St Nw Vienna VA 22180-4102 |
| Practice Telephone | 4105323904 |
| Practice Fax Number | 4105324599 |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-03-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
C0007493 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5601 LOCH RAVEN BLVD |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21239-2945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316940588 | Paul Byron Fowler | Specialist | 5601 Loch Raven Blvd, Baltimore, MD 21239-2905 | 2005-05-23 |
| 1992328017 | Kaitlin Lee | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2020-05-22 |
| 1023646692 | Akiko Rockers | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2020-03-30 |
| 1578199519 | Erica Wilson | Pharmacist | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2020-03-22 |
| 1679103576 | Nerland Dimanche | Registered Nurse | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2020-01-20 |
| 1063058782 | Simcha Gratz | Nurse Practitioner | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2019-11-19 |
| 1548817737 | Christopher Burgess | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2019-08-22 |
| 1114571809 | Lauren Delmonico | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2019-07-30 |
| 1750943411 | Sana Tanveer Ahmed | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2019-07-02 |
| 1336704675 | Shanna Danielle Raphael | Physician Assistant | 5601 Loch Raven Blvd, Baltimore, MD 21239-2945 | 2019-05-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255809273 | Books of Color, LLC | Student in an Organized Health Care Education/Training Program | 1222 Walker Ave, Baltimore, MD 21239 | 2018-11-07 |
| 1902381353 | Brandon Wilson | Physician Assistant | 5601 Lochraven Blvd, Baltimore, MD 21239 | 2018-10-02 |
| 1629563879 | Ashley C Sayles | Nurse Practitioner | 5601 Loch Raven Blvd Ste 200, Baltimore, MD 21239 | 2018-06-28 |
| 1164940656 | Tarnisha Fitzgerald | Nurse Practitioner | 1601 East Belvedere Avenue, Baltimore, MD 21239 | 2017-09-05 |
| 1083153803 | J.pope & Associates, LLC | Counselor | 1800 E. Northern Pkwy #28031, Baltimore, MD 21239 | 2017-02-13 |
| 1417336017 | Mana Ali | Psychologist | 5601 Loch Raven Blvd Ste 406, Johns Hopkins Som Dept of Physical Med and Rehab, Baltimore, MD 21239 | 2015-05-28 |
| 1730597766 | Ramona Taylor-knox | Counselor | 1700 Meridian Drive, Suite 611, Baltimore, MD 21239 | 2014-07-22 |
| 1013259142 | Innovative Healing Solutions,llc | Social Worker | 1302 Silverthorne Rd, Baltimore, MD 21239 | 2013-03-27 |
| 1962744268 | Mohamad Hanouneh | Internal Medicine | 5601 Loch Raven Blvd Ste 3n, Baltimore, MD 21239 | 2013-03-25 |
| 1164713350 | Vanessa G Brown | Pharmacist | 5618 The Alameda, Baltimore, MD 21239 | 2011-04-22 |
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| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306341540 | Sunil Harris | Physician Assistant | 22 S. Green St, University of Maryland Medical Center, Baltimore, MD 21201-1595 | 2018-03-29 |
| 1134639263 | Liz Ramirez | Physician Assistant | 1101 E 33rd St, Baltimore, MD 21218-3637 | 2017-10-03 |
| 1093231755 | Daniel Gentry | Physician Assistant | 301 Saint Paul St Ste Pob 802, Baltimore, MD 21202-2102 | 2017-08-15 |
| 1174051353 | Nam Anh Pham | Physician Assistant | 227 Saint Paul St Fl 6, Baltimore, MD 21202-2001 | 2017-05-31 |
| 1528516879 | Chesapeake Bay Surgical Assistants | Physician Assistant | 6814 Chand Ct, Baltimore, MD 21237-3869 | 2016-09-15 |
| 1598172801 | Krista D Aghazarian | Physician Assistant | 227 Saint Paul St Fl 5, Baltimore, MD 21202-2001 | 2014-07-18 |
| 1831525997 | Michael Prada | Physician Assistant | 301 St. Paul Place, Lower Level, Maryland Spine Center At Mercy, Baltimore, MD 21202 | 2013-09-20 |
| 1871862748 | Arifa Rabia Sattar | Physician Assistant | 2900 S Hanover St Ste 105, Baltimore, MD 21225-1232 | 2011-12-22 |
| 1316180128 | Stanislav Mihaylov Stanislavov | Physician Assistant | 601 N Caroline St Fl 5, Baltimore, MD 21287-0006 | 2009-04-08 |
| 1780846402 | Annie Wong Kowalis | Physician Assistant | 2435 W Belvedere Avenue, Suite 42, Baltimore, MD 21215-5224 | 2008-06-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.