Provider Demographics
NPI:1326655614
Name:JENKINS, YVETTE MONIQUE (PMHNP)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MONIQUE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:MONIQUE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2704 WOOD DALE DR APT 17B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6785
Mailing Address - Country:US
Mailing Address - Phone:662-871-8899
Mailing Address - Fax:
Practice Address - Street 1:2704 WOOD DALE DR APT 17B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6785
Practice Address - Country:US
Practice Address - Phone:662-871-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868950163WP0807X, 163WP0808X
MS904783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health