Healthcare Provider Details

I. General information

NPI: 1861746240
Provider Name (Legal Business Name): LILA L JENKINS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST 4TH FLOOR
AKRON OH
44310-3110
US

IV. Provider business mailing address

525 E MARKET ST PO BOX 2090
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-9548
  • Fax: 330-379-5124
Mailing address:
  • Phone: 330-996-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA-13861-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: