Healthcare Provider Details

I. General information

NPI: 1619824125
Provider Name (Legal Business Name): KIARA JENKINS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MCGEE ST
BAMBERG SC
29003-1154
US

IV. Provider business mailing address

86 WREN ST
BARNWELL SC
29812-1529
US

V. Phone/Fax

Practice location:
  • Phone: 803-956-6100
  • Fax:
Mailing address:
  • Phone: 803-259-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number31681
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: