Healthcare Provider Details

I. General information

NPI: 1659206563
Provider Name (Legal Business Name): DEMETRA M JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 ORMOND MEADOWS DR
DESTREHAN LA
70047-4027
US

IV. Provider business mailing address

86 ORMOND MEADOWS DR
DESTREHAN LA
70047-4027
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-4577
  • Fax:
Mailing address:
  • Phone: 504-250-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: