Healthcare Provider Details

I. General information

NPI: 1396260881
Provider Name (Legal Business Name): ASHLEY BRITTNEY JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 HEALTHWAY DR
BERLIN MD
21811-1154
US

IV. Provider business mailing address

6040 PUBLIC LANDING RD
SNOW HILL MD
21863-2453
US

V. Phone/Fax

Practice location:
  • Phone: 410-629-0164
  • Fax: 410-629-0185
Mailing address:
  • Phone: 410-632-1100
  • Fax: 410-632-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: