MEDICARE: TRAVIS JENKINS MD

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	2084P0800X	Psychiatry Physician	C4068	AR

General Provider Information

NPI Number	:	1417902123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS JENKINS MD

Provider Business Mailing Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

Provider Business Practice Location Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/17/2017

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