Provider Demographics
NPI:1508529140
Name:JENKINS, ARDIE III
Entity Type:Individual
Prefix:
First Name:ARDIE
Middle Name:
Last Name:JENKINS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 E MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-9269
Mailing Address - Country:US
Mailing Address - Phone:480-534-4000
Mailing Address - Fax:
Practice Address - Street 1:2735 E MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-9269
Practice Address - Country:US
Practice Address - Phone:480-534-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician