MEDICARE: EMILY J 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	208000000X	Pediatrics Physician	352255	LA

General Provider Information

NPI Number	:	1588595292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY J JENKINS

Provider Business Mailing Address
First Line	:	1028 N CRESCENT CV
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-6239
Country	:	US
Telephone Number	:	318-655-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 N CRESCENT CV
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-6239
Country	:	US
Telephone Number	:	318-655-5160
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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