Provider Demographics
NPI:1467003632
Name:JENKINS, KYUANTE
Entity Type:Individual
Prefix:MS
First Name:KYUANTE
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 1:8302 N STERLING LAKES DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3760
Mailing Address - Country:US
Mailing Address - Phone:678-683-2527
Mailing Address - Fax:
Practice Address - Street 1:8302 N STERLING LAKES DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3760
Practice Address - Country:US
Practice Address - Phone:678-683-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health