Healthcare Provider Details

I. General information

NPI: 1659218089
Provider Name (Legal Business Name): LAURA JEAN JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 COUNTY ROAD 335
KOSHKONONG MO
65692-7609
US

IV. Provider business mailing address

926 COUNTY ROAD 335
KOSHKONONG MO
65692-7609
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-4824
  • Fax:
Mailing address:
  • Phone: 417-257-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2017018480
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: