Provider Demographics
NPI:1396178687
Name:JENKINS, GLINDA FAYE (RN)
Entity Type:Individual
Prefix:
First Name:GLINDA
Middle Name:FAYE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 QUIET LN
Mailing Address - Street 2:PO BOX 344
Mailing Address - City:JACKSON
Mailing Address - State:LA
Mailing Address - Zip Code:70748-5710
Mailing Address - Country:US
Mailing Address - Phone:225-634-5715
Mailing Address - Fax:
Practice Address - Street 1:4336 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3920
Practice Address - Country:US
Practice Address - Phone:225-343-9505
Practice Address - Fax:225-343-9141
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse