Provider Demographics
NPI:1275012908
Name:JENSEN, JESSICA RAYE (PAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAYE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5517
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5517
Mailing Address - Country:US
Mailing Address - Phone:252-075-1554
Mailing Address - Fax:
Practice Address - Street 1:1200 W NORTHERN LIGHTS BLVD STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3652
Practice Address - Country:US
Practice Address - Phone:907-212-5165
Practice Address - Fax:907-212-0950
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK155221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant