MEDICARE: KRISTEN LEIGH JANSSEN P.A.

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
1	363A00000X	Physician Assistant	745	CO

General Provider Information

NPI Number	:	1982679130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEIGH JANSSEN P.A.

Provider Business Mailing Address
First Line	:	7050 AIR DEPOT BLVD BLDG 1094
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8716
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:	405-736-3128

Provider Business Practice Location Address
First Line	:	7050 AIR DEPOT BLVD BLDG 1094
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8716
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	01/20/2026

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