Healthcare Provider Details

I. General information

NPI: 1164938767
Provider Name (Legal Business Name): ASHLEY RYSHIA MARIE JENKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY RYSHIA MARIE JENKINS BOARD LICENSE

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 07/08/2022
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 WYOMING BLVD NE STE 102D
ALBUQUERQUE NM
87111-3286
US

IV. Provider business mailing address

5508 CARMELITA DR NE
ALBUQUERQUE NM
87111-1739
US

V. Phone/Fax

Practice location:
  • Phone: 520-342-9023
  • Fax:
Mailing address:
  • Phone: 520-342-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: