Provider Demographics
NPI:1164935896
Name:JENKINS, SHEREKA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:SHEREKA
Middle Name:MICHELLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11847 CANON BLVD STE 11B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4579
Mailing Address - Country:US
Mailing Address - Phone:757-697-9288
Mailing Address - Fax:959-777-3873
Practice Address - Street 1:11847 CANON BLVD STE 11B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4579
Practice Address - Country:US
Practice Address - Phone:757-697-9288
Practice Address - Fax:959-777-3873
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAAG11170050363L00000X
VA0024175684363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner