Provider Demographics
NPI:1124712443
Name:JENSEN, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28243 409TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-6217
Mailing Address - Country:US
Mailing Address - Phone:712-592-8987
Mailing Address - Fax:
Practice Address - Street 1:3100 E SD HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-6804
Practice Address - Country:US
Practice Address - Phone:605-773-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002833207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine