Healthcare Provider Details

I. General information

NPI: 1417321761
Provider Name (Legal Business Name): LAKEISHA JENKINS DNP, FNP-C, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 KELLY RD
MCDONOUGH GA
30253-6097
US

IV. Provider business mailing address

50 KELLY RD
MCDONOUGH GA
30253-6097
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-1887
  • Fax: 770-957-6864
Mailing address:
  • Phone: 770-957-1887
  • Fax: 770-957-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11012880
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN219808
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346398
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408894
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0107083
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5781928
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: