Healthcare Provider Details

I. General information

NPI: 1437266541
Provider Name (Legal Business Name): PAMELA GAYLE JENKINS LPN II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLSH/RRTC UNIT # 6 MEADOW LANE
PINEVILLE LA
71360
US

IV. Provider business mailing address

712 DASPIT ST
ALEXANDRIA LA
71302-5339
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6354
  • Fax:
Mailing address:
  • Phone: 318-448-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number920009
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: