Healthcare Provider Details

I. General information

NPI: 1407380231
Provider Name (Legal Business Name): AMELIA MARTIN JENKINS CST, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 PRIMROSE DR
NEW ORLEANS LA
70126-1944
US

IV. Provider business mailing address

7717 PRIMROSE DR
NEW ORLEANS LA
70126-1944
US

V. Phone/Fax

Practice location:
  • Phone: 504-919-6904
  • Fax:
Mailing address:
  • Phone: 504-919-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number160554
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: