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NPI Code Detail

MEDICARE: COREY JENKINS M.,S

MEDICARE: COREY JENKINS M.,S
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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1790164366
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY JENKINS M.,S
Provider Business Mailing Address
First Line : 415 COURT ST
Second Line :
City : PORT ALLEN
State : LA
Zip : 70767-2747
Country : US
Telephone Number : 225-245-9070
Fax Number : 225-245-9070
Provider Business Practice Location Address
First Line : 555 SAINT TAMMANY ST STE D
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6064
Country : US
Telephone Number : 225-929-9738
Fax Number : 225-929-9740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2015
Last Update Date : 12/14/2020

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