Provider Demographics
NPI:1720051808
Name:PHILLIPS, KAREN SUE JENSEN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE JENSEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 DON PASQUAL RD NW
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8841
Mailing Address - Country:US
Mailing Address - Phone:505-865-4618
Mailing Address - Fax:505-224-8727
Practice Address - Street 1:145 DON PASQUAL RD NW
Practice Address - Street 2:SUITE 116
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8841
Practice Address - Country:US
Practice Address - Phone:505-865-4618
Practice Address - Fax:505-224-8727
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ4985Medicaid
NMQ4985Medicaid