Healthcare Provider Details

I. General information

NPI: 1356742043
Provider Name (Legal Business Name): QUALYNN S. JENKINS APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QUA'LYNN S. JENKINS LPC

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 LAKE ST
LAKE CHARLES LA
70601-8211
US

IV. Provider business mailing address

2529 LAKE ST
LAKE CHARLES LA
70601-8211
US

V. Phone/Fax

Practice location:
  • Phone: 337-912-9758
  • Fax:
Mailing address:
  • Phone: 337-912-9758
  • Fax: 337-735-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08021
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP08021
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAP08021
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: