Healthcare Provider Details

I. General information

NPI: 1144734963
Provider Name (Legal Business Name): LA'WANDA Y. JENKINS DNP, APN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 WREN RD STE A
GOODLETTSVILLE TN
37072-2312
US

IV. Provider business mailing address

704 TUCKAHOE DR
MADISON TN
37115-3429
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-3063
  • Fax: 615-420-6413
Mailing address:
  • Phone: 615-337-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number353093-01
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: