Provider Demographics
NPI:1417539206
Name:JENKINS, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
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 1:1039 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HERMANVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39086-9506
Mailing Address - Country:US
Mailing Address - Phone:601-702-1024
Mailing Address - Fax:
Practice Address - Street 1:1039 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:HERMANVILLE
Practice Address - State:MS
Practice Address - Zip Code:39086-9506
Practice Address - Country:US
Practice Address - Phone:601-702-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32055376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS32055OtherSTATE OF MS NURSE AIDE