Organization
KEY STONE HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD R JENSEN FNP (PRESIDENT)
(503) 523-6404
Entity
Organization
Contact information
Practice address
21 N FISHER PARK WAY, EAGLE, ID 83616-4796
(208) 514-0670
(208) 549-7880
Mailing address
21 N FISHER PARK WAY, EAGLE, ID 83616-4796
(208) 514-0670
(208) 549-7880
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
363LG0600X
Gerontology Nurse Practitioner
Primary
NP-1166A
ID
Other
Enumeration date
12/23/2013
Last updated
12/11/2020
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