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General NPI Number Information
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NPI Number | 1689519696
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Entity Type | Individual
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Provider Name | ALICIA DANIELLE JENKINS
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Gender | Female
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | PO BOX 30643
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City | SAVANNAH
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State | GA
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Zip | 31410-0643
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Country | US
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Telephone | 800-566-1307
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Fax | 888-314-2974
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Provider Business Mailing Address
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Address Line | 4801 N BROOKSHIRE ST
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City | OZARK
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State | MO
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Zip | 65721-7211
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 133454
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License Number State | MO
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