Healthcare Provider Details

I. General information

NPI: 1760390587
Provider Name (Legal Business Name): DNAISHA MIA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 ARGENT BLVD
RIDGELAND SC
29936-3266
US

IV. Provider business mailing address

64 HICKORY ST
RIDGELAND SC
29936-6100
US

V. Phone/Fax

Practice location:
  • Phone: 854-204-0440
  • Fax:
Mailing address:
  • Phone: 843-226-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: