MEDICARE: MISS KIMBERLY L JENKINS I

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	251E00000X	Home Health Agency	00483595	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285298463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY L JENKINS I

Provider Business Mailing Address
First Line	:	226 BEACH 98TH ST # 3
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2849
Country	:	US
Telephone Number	:	718-569-0508
Fax Number	:	833-318-2363

Provider Business Practice Location Address
First Line	:	226 BEACH 98TH ST # 3
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2849
Country	:	US
Telephone Number	:	718-569-0508
Fax Number	:	833-318-2363

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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