Provider Demographics
NPI:1215740675
Name:WHARTON, JENSON KYA
Entity type:Individual
Prefix:
First Name:JENSON
Middle Name:KYA
Last Name:WHARTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENSEN
Other - Middle Name:KYA
Other - Last Name:WHARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28906 SHINGLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9658
Mailing Address - Country:US
Mailing Address - Phone:530-638-1610
Mailing Address - Fax:
Practice Address - Street 1:28906 SHINGLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9658
Practice Address - Country:US
Practice Address - Phone:530-638-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula