Provider Demographics
NPI:1306652821
Name:JENKINS, JESSICA-MAE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:JESSICA-MAE
Middle Name:ELIZABETH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5233 GLEN EAGLES LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-1406
Mailing Address - Country:US
Mailing Address - Phone:702-981-0490
Mailing Address - Fax:
Practice Address - Street 1:7260 W AZURE DR STE 140-44
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-7999
Practice Address - Country:US
Practice Address - Phone:702-789-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician