Provider Demographics
NPI:1225849268
Name:JENKINS, SHERRALL (OD)
Entity type:Individual
Prefix:DR
First Name:SHERRALL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W WOODROW WILSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7697
Mailing Address - Country:US
Mailing Address - Phone:601-366-9020
Mailing Address - Fax:601-321-3979
Practice Address - Street 1:7118 S SIWELL RD STE B-1
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8744
Practice Address - Country:US
Practice Address - Phone:601-373-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist