MEDICARE: MRS. KACEY D JENKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	3476	TX

General Provider Information

NPI Number	:	1417807835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KACEY D JENKINS

Provider Business Mailing Address
First Line	:	1811 TIMBERLINE DR
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-1677
Country	:	US
Telephone Number	:	903-244-8669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3718 SUMMERHILL RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3566
Country	:	US
Telephone Number	:	903-793-6135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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