Provider Demographics
NPI:1316653512
Name:JENSEN, KATLIN LEE (CRNP)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:LEE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 LOWER DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LACEYS SPRING
Mailing Address - State:AL
Mailing Address - Zip Code:35754-3716
Mailing Address - Country:US
Mailing Address - Phone:507-829-7707
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4470
Practice Address - Country:US
Practice Address - Phone:256-265-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-179544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care