Active NPI
Paul Hartly Jenkins, PSY.D.
- Psychologist
- Sacramento, CA
National Provider Identifier
1487764569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY18620
- Practice address
- 2711 Creekside LN
Sacramento, CA 95821-6128 - Phone
- (916) 484-7679
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY18620 | CA | Primary |
Addresses
Primary practice location
2711 Creekside LN
Sacramento, CA 95821-6128
Mailing address
2711 Creekside LN
Sacramento, CA 95821-6128
Phone (916) 484-7679
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18620 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Coast Psychiatric Associates Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- Scottsdale, AZ
- NPI 1023125465
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1487764569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2711 CREEKSIDE LN",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958216128",
"telephone_number": "916-484-7679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 CREEKSIDE LN",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958216128",
"telephone_number": "916-484-7679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "PAUL",
"middle_name": "HARTLY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY18620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.