Provider Demographics
NPI:1285951079
Name:JENSON, CHARLES (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:JENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11321 INTERSTATE 30 STE 304
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7067
Mailing Address - Country:US
Mailing Address - Phone:501-202-7587
Mailing Address - Fax:501-202-7513
Practice Address - Street 1:11321 INTERSTATE 30 STE 304
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209
Practice Address - Country:US
Practice Address - Phone:501-202-7587
Practice Address - Fax:501-202-7513
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1672722084P0800X
390200000X
ARE114782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program