Provider Demographics
NPI:1316628332
Name:JENKINS, REGINA LASHAWNE
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LASHAWNE
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 1:2 NOBLE JONES CT
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-6025
Mailing Address - Country:US
Mailing Address - Phone:706-840-5351
Mailing Address - Fax:912-964-9381
Practice Address - Street 1:2 NOBLE JONES CT
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-6025
Practice Address - Country:US
Practice Address - Phone:706-840-5351
Practice Address - Fax:912-964-9381
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula