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General NPI Number Information
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NPI Number | 1689134025
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Entity Type | Individual
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Provider Name | KYONG ANN JENKINS
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 2178 SAVANNAH HWY STE 108
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City | CHARLESTON
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State | SC
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Zip | 29414-5311
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Country | US
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Telephone | 843-530-7594
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 323
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City | COTTAGEVILLE
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State | SC
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Zip | 29435-0323
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Country | US
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Telephone | 843-530-7594
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 561790
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License Number State | SC
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