Provider Demographics
NPI:1396909669
Name:JENKINS, KIMARA (SLP)
Entity type:Individual
Prefix:
First Name:KIMARA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SHERATON DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2045
Mailing Address - Country:US
Mailing Address - Phone:501-447-5646
Mailing Address - Fax:
Practice Address - Street 1:25 SHERATON DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2045
Practice Address - Country:US
Practice Address - Phone:501-447-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2031251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116837743Medicaid