1912181900 NPI number — DR. COLIBRI NECOLE JENKINS MD

Table of content: DR. COLIBRI NECOLE JENKINS MD (NPI 1912181900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912181900 NPI number — DR. COLIBRI NECOLE JENKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
COLIBRI
Provider Middle Name:
NECOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912181900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111N FRONTAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICKSBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39180-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-883-3650
Provider Business Mailing Address Fax Number:
601-883-3362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 CANAL ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY AND NEUROLOGY TB5
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-988-4272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  PGY1TULPSY , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)