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General NPI Number Information
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NPI Number | 1164935896
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Entity Type | Individual
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Provider Name | SHEREKA MICHELLE JENKINS NP
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Gender | Female
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 11847 CANON BLVD STE 11B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4579
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Country | US
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Telephone | 757-697-9288
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Fax | 959-777-3873
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Provider Business Mailing Address
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Address Line | 11847 CANON BLVD STE 11B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4579
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Country | US
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Telephone | 757-697-9288
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Fax | 959-777-3873
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AG11170050
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024175684
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License Number State | VA
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