Healthcare Provider Details

I. General information

NPI: 1053078998
Provider Name (Legal Business Name): JOSHUA BENJAMIN JENKINS M.S. PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 DELAWARE AVE
BUFFALO NY
14209-2006
US

IV. Provider business mailing address

768 DELAWARE AVE
BUFFALO NY
14209-2006
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-2587
  • Fax: 716-261-1006
Mailing address:
  • Phone: 716-856-2587
  • Fax: 716-261-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404935-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number703978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: