Active NPI
Raquel Jenkins
- Prevention Professional
- Black Jack, MO
National Provider Identifier
1558247486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 855544
- Practice address
- 13755 Old Halls Ferry Rd
Black Jack, MO 63033-4129 - Phone
- (314) 915-3358
- NPI assigned
- Aug 14, 2025
- Last updated
- Aug 14, 2025
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 855544 | MO | Primary |
Addresses
Primary practice location
13755 Old Halls Ferry Rd
Black Jack, MO 63033-4129
Mailing address
61 Brookhill CT
Collinsville, IL 62234-6044
Phone (314) 915-3358
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 |
|---|---|---|---|
| 855544 | MO | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755129600000",
"number": "1558247486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 BROOKHILL CT",
"city": "COLLINSVILLE",
"state": "IL",
"postal_code": "622346044",
"telephone_number": "314-915-3358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13755 OLD HALLS FERRY RD",
"city": "BLACK JACK",
"state": "MO",
"postal_code": "630334129",
"telephone_number": "314-915-3358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "RAQUEL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-14",
"last_updated": "2025-08-14",
"certification_date": "2025-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MO",
"license": "855544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Black Jack, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.