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General NPI Number Information
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NPI Number | 1063697019
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Entity Type | Individual
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Provider Name | MRS. DETRIA S JENKINS
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 130 DESIARD ST SUITE 412
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City | MONROE
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State | LA
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Zip | 71201-7319
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Country | US
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Telephone | 318-387-3545
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Fax | 318-387-3541
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Provider Business Mailing Address
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Address Line | PO BOX 1222
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City | WEST MONROE
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State | LA
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Zip | 71294-1222
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Country | US
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Telephone | 318-387-3545
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Fax | 318-387-3541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | PCA 14071
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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