Individual
KELLY M JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6401 PRAIRIE ST, SUITE 2300, NORTON SHORES, MI 49444-7840
(231) 727-7928
(231) 724-7844
Mailing address
PO BOX 1847, MUSKEGON, MI 49443-1847
(231) 727-7948
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003267
MI
363AM0700X
Medical Physician Assistant
5601003267
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N34010012
MEDICARE PTAN
MI
Enumeration date
10/02/2006
Last updated
07/09/2019
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