Provider Demographics
NPI:1760417729
Name:JENKINS, TARYLL LAMONT (MD)
Entity Type:Individual
Prefix:DR
First Name:TARYLL
Middle Name:LAMONT
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23920 KATY FREEWAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-347-2600
Mailing Address - Fax:
Practice Address - Street 1:23920 KATY FREEWAY
Practice Address - Street 2:SUITE 215
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-347-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067NSOtherBLUE CROSS BLUE SHIELD TX
TX180539201Medicaid
TX10074714OtherAMERIGROUP
TX180539201Medicaid
TX8F3897Medicare PIN