Provider Demographics
NPI:1487764569
Name:JENKINS, PAUL HARTLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HARTLY
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6128
Mailing Address - Country:US
Mailing Address - Phone:916-484-7679
Mailing Address - Fax:
Practice Address - Street 1:2711 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6128
Practice Address - Country:US
Practice Address - Phone:916-484-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist