Provider Demographics
NPI:1306613559
Name:JENSON-BAGULEY, KIMBERLY ALICIA
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALICIA
Last Name:JENSON-BAGULEY
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 1:7497 N ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6030
Mailing Address - Country:US
Mailing Address - Phone:801-691-3403
Mailing Address - Fax:
Practice Address - Street 1:3165 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2115
Practice Address - Country:US
Practice Address - Phone:801-691-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN