Healthcare Provider Details

I. General information

NPI: 1912559774
Provider Name (Legal Business Name): JENNIFER JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CLAIRE CT
ARLINGTON TX
76012-4832
US

IV. Provider business mailing address

PO BOX 41072
DALLAS TX
75241-0072
US

V. Phone/Fax

Practice location:
  • Phone: 469-386-4428
  • Fax:
Mailing address:
  • Phone: 469-386-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: