Provider Demographics
NPI:1033247101
Name:JENKINS, EDNA DARLENE (BA)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:DARLENE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-4852
Mailing Address - Country:US
Mailing Address - Phone:931-433-6456
Mailing Address - Fax:931-433-8911
Practice Address - Street 1:2241 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3637
Practice Address - Country:US
Practice Address - Phone:931-433-6456
Practice Address - Fax:931-433-8911
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker