Healthcare Provider Details

I. General information

NPI: 1417789041
Provider Name (Legal Business Name): LINDSEY JENKINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

PO BOX 669379
DALLAS TX
75266-9379
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4000
  • Fax: 985-898-4164
Mailing address:
  • Phone: 985-898-4451
  • Fax: 985-898-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number343179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: