Provider Demographics
NPI:1427656818
Name:JELKS, KIMAYA
Entity type:Individual
Prefix:MS
First Name:KIMAYA
Middle Name:
Last Name:JELKS
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 1:301 HALL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-9552
Mailing Address - Country:US
Mailing Address - Phone:731-616-3374
Mailing Address - Fax:
Practice Address - Street 1:1869 45 HWY BYPASS
Practice Address - Street 2:SUITE 2B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-616-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist