Provider Demographics
NPI:1164848164
Name:JENKINS, LATESHA
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:
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 1:3768 DRESDEN DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205
Mailing Address - Country:US
Mailing Address - Phone:704-690-1342
Mailing Address - Fax:
Practice Address - Street 1:3768 DRESDEN DR E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6308
Practice Address - Country:US
Practice Address - Phone:704-690-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health