Healthcare Provider Details

I. General information

NPI: 1225965635
Provider Name (Legal Business Name): DIANE JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE S
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

5536 BURLINGTON LN
WILLIAMSBURG VA
23188-7598
US

V. Phone/Fax

Practice location:
  • Phone: 888-903-5369
  • Fax:
Mailing address:
  • Phone: 888-903-5369
  • Fax: 757-299-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: