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NPI Code Detail

MEDICARE: DR. NATHAN KENNETH JANSEN D.O.

MEDICARE: DR. NATHAN KENNETH JANSEN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician71784GA
2207RI0200XInfectious Disease Physician071784GA

General Provider Information

NPI Number : 1578828158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN KENNETH JANSEN D.O.
Provider Business Mailing Address
First Line : 18511 HIGHLANDER MEDICS ST
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-5327
Country : US
Telephone Number : 915-742-0493
Fax Number : 915-742-2748
Provider Business Practice Location Address
First Line : 18511 HIGHLANDER MEDICS ST
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-5327
Country : US
Telephone Number : 915-742-0493
Fax Number : 915-742-2748
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2012
Last Update Date : 03/10/2026

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