MEDICARE: QUALYNN S. JENKINS APRN FNP-C

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	101Y00000X	Counselor	AP08021	LA
2	363LF0000X	Family Nurse Practitioner	AP08021	LA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP08021	LA

General Provider Information

NPI Number	:	1356742043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUALYNN S. JENKINS APRN FNP-C

Provider Business Mailing Address
First Line	:	2529 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8211
Country	:	US
Telephone Number	:	337-912-9758
Fax Number	:	337-735-9760

Provider Business Practice Location Address
First Line	:	2529 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8211
Country	:	US
Telephone Number	:	337-912-9758
Fax Number	:

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

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/17/2025

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