Provider Demographics
NPI:1396126983
Name:JENSON, DAVID (DNP, PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JENSON
Suffix:
Gender:M
Credentials:DNP, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-583-1000
Mailing Address - Fax:866-323-8458
Practice Address - Street 1:3212 N WINDSONG DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-583-1000
Practice Address - Fax:866-751-4157
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7855363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042864Medicaid
AZZ180918Medicare PIN