Basic Information
| Provider Information | |||||||||
| NPI: | 1720077084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | LEIGH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794309410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G5217 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | G5217 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | G5217 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 115996101 | 05 | TX | MEDICAID | 118493903 | 05 | TX | MEDICAID | 118493901 | 05 | TX | MEDICAID | 85E555 | 01 | TX | BC/BS | OTHER | 80899Z | 01 | TX | HMO BLUE | OTHER | A027 | 01 | TRIWEST | OTHER | 100138800A | 05 | OK | MEDICAID | 52370 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER | 115996100 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 52370 | 05 | NM | MEDICAID | X5390 | 05 | NM | MEDICAID |