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NPI Code Detail

MEDICARE: MR. KEITH ALLEN JENKINS DNP, PMHNP-BC, FNP

MEDICARE: MR. KEITH ALLEN JENKINS DNP, PMHNP-BC, FNP
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
1363LF0000XFamily Nurse Practitioner19606TN
2363LF0000XFamily Nurse Practitioner4704335557MI
3363LF0000XFamily Nurse Practitioner95010338CA
4363LP0808XPsychiatric/Mental Health Nurse Practitioner19606TN
5363LP0808XPsychiatric/Mental Health Nurse Practitioner95010338CA

General Provider Information

NPI Number : 1700274974
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH ALLEN JENKINS DNP, PMHNP-BC, FNP
Provider Business Mailing Address
First Line : 1640 NEWPORT BLVD STE 110
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-7762
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1640 NEWPORT BLVD STE 110
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-7762
Country : US
Telephone Number : 925-282-1778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2014
Last Update Date : 03/27/2025

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