Provider Demographics
NPI:1164938767
Name:JENKINS, ASHLEY RYSHIA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RYSHIA MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RYSHIA MARIE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BOARD LICENSE
Mailing Address - Street 1:5508 CARMELITA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1739
Mailing Address - Country:US
Mailing Address - Phone:520-342-9023
Mailing Address - Fax:
Practice Address - Street 1:3620 WYOMING BLVD NE STE 102D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3286
Practice Address - Country:US
Practice Address - Phone:520-342-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22390OtherARIZONA MASSAGE BOARD