Provider Demographics
NPI:1932833662
Name:JENSEN, NIKKI DAWN
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:DAWN
Last Name:JENSEN
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 1:7127 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9136
Mailing Address - Country:US
Mailing Address - Phone:405-858-1762
Mailing Address - Fax:
Practice Address - Street 1:7127 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9136
Practice Address - Country:US
Practice Address - Phone:405-858-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist