MEDICARE: DAMARCO KIJIER 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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1568254316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMARCO KIJIER JENKINS

Provider Business Mailing Address
First Line	:	1739 OHIO AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 OHIO AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2155
Country	:	US
Telephone Number	:	234-410-6973
Fax Number	:

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

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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