MEDICARE: JEWEL R 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	164X00000X	Licensed Vocational Nurse	1215080	TX

General Provider Information

NPI Number	:	1467316786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWEL R JENKINS

Provider Business Mailing Address
First Line	:	4100 NORTHERN CROSS BLVD APT 8309
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-6470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 NORTHERN CROSS BLVD APT 8309
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-6470
Country	:	US
Telephone Number	:	914-230-8379
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “ JEWEL R JENKINS ” Practice Location

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