Provider Demographics
NPI:1952746364
Name:JENKINS, TERRELL C (MHPP)
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 SANDINO DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-9270
Mailing Address - Country:US
Mailing Address - Phone:870-919-7577
Mailing Address - Fax:
Practice Address - Street 1:1217 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4520
Practice Address - Country:US
Practice Address - Phone:870-972-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator