MEDICARE: KAYELA JENKINS LCSW

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	1041C0700X	Clinical Social Worker	61133	TX

General Provider Information

NPI Number	:	1649156878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYELA JENKINS LCSW

Provider Business Mailing Address
First Line	:	2204 PARK PLACE AVE STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1234
Country	:	US
Telephone Number	:	682-252-3830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6115 CAMP BOWIE BLVD STE 240
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5502
Country	:	US
Telephone Number	:	682-292-8515
Fax Number	:

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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