Provider Demographics
NPI:1952039992
Name:JENKINS, KESHIA M
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:M
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 1:2502 WALDEMAR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1252
Mailing Address - Country:US
Mailing Address - Phone:850-543-3460
Mailing Address - Fax:
Practice Address - Street 1:2502 WALDEMAR LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1252
Practice Address - Country:US
Practice Address - Phone:850-543-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FLRBT23257072106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician