Provider Demographics
NPI:1437923471
Name:JENKINS, TATIA LXCHELLE
Entity Type:Individual
Prefix:
First Name:TATIA
Middle Name:LXCHELLE
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 1:11861 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4404
Mailing Address - Country:US
Mailing Address - Phone:225-612-8656
Mailing Address - Fax:225-341-8774
Practice Address - Street 1:11861 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4404
Practice Address - Country:US
Practice Address - Phone:225-612-8656
Practice Address - Fax:225-341-8774
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator