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General NPI Number Information
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NPI Number | 1417807835
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Entity Type | Individual
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Provider Name | MRS. KACEY D JENKINS
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Gender | Female
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 3718 SUMMERHILL RD
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City | TEXARKANA
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State | TX
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Zip | 75503-3566
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Country | US
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Telephone | 903-793-6135
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 TIMBERLINE DR
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City | TEXARKANA
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State | AR
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Zip | 71854-1677
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Country | US
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Telephone | 903-244-8669
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 3476
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License Number State | TX
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