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NPI Code Detail

MEDICARE: DEBRA LEE JENKINS PMHNP-BC

MEDICARE: DEBRA LEE JENKINS PMHNP-BC
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
1320800000XMental Illness Community Based Residential Treatment FacilitySP033570PA

General Provider Information

NPI Number : 1407371388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA LEE JENKINS PMHNP-BC
Provider Business Mailing Address
First Line : 100 PARK ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-2023
Country : US
Telephone Number : 570-290-8780
Fax Number :
Provider Business Practice Location Address
First Line : 100 PARK ST
Second Line :
City : HONESDALE
State : PA
Zip : 18431-2023
Country : US
Telephone Number : 570-290-8780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2017
Last Update Date : 03/09/2026

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