Provider Demographics
NPI:1598254773
Name:JENKINS, JIA SHA'RONDA (LVN)
Entity Type:Individual
Prefix:MS
First Name:JIA
Middle Name:SHA'RONDA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 HARTT ST
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:TX
Mailing Address - Zip Code:75946-2219
Mailing Address - Country:US
Mailing Address - Phone:936-347-3532
Mailing Address - Fax:
Practice Address - Street 1:427 HARTT ST
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:TX
Practice Address - Zip Code:75946-2219
Practice Address - Country:US
Practice Address - Phone:936-347-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308034164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse