Healthcare Provider Details

I. General information

NPI: 1003292046
Provider Name (Legal Business Name): KIARA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 PEARL ST SW
WARREN OH
44485-3650
US

IV. Provider business mailing address

1184 PEARL ST SW
WARREN OH
44485-3650
US

V. Phone/Fax

Practice location:
  • Phone: 567-219-3045
  • Fax:
Mailing address:
  • Phone: 567-219-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number0132488
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number0132488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: