MEDICARE: MIRANDA JENKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114378346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA JENKINS

Provider Business Mailing Address
First Line	:	6201 BERT KOUN LOOP
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 BERT KOUN LOOP
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5056
Country	:	US
Telephone Number	:	318-272-5768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	01/14/2019

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Directions to “ MIRANDA JENKINS ” Practice Location

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