Provider Demographics
NPI:1326866757
Name:JENSEN, KAITLYN (CNM)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY STE 409
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3746
Mailing Address - Country:US
Mailing Address - Phone:677-204-7212
Mailing Address - Fax:443-481-4151
Practice Address - Street 1:2003 MEDICAL PKWY STE G50
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3067
Practice Address - Country:US
Practice Address - Phone:443-481-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR239348163WM0102X
MD367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn