Provider Demographics
NPI:1114220803
Name:JENKINS, KERI LEIGH
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LEIGH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 36TH AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4113
Mailing Address - Country:US
Mailing Address - Phone:405-990-0816
Mailing Address - Fax:405-735-6116
Practice Address - Street 1:1139 36TH AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4113
Practice Address - Country:US
Practice Address - Phone:405-990-0816
Practice Address - Fax:405-735-6116
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK081240263101YM0800X
OKLPC06697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health