Individual
MR. KEITH C JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2438
(970) 350-2473
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2438
(970) 350-2473
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3319
CO
363AS0400X
Surgical Physician Assistant
PA-3319
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49471554
—
CO
Enumeration date
10/13/2011
Last updated
08/13/2013
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