Healthcare Provider Details

I. General information

NPI: 1346322500
Provider Name (Legal Business Name): JEREMY ALLEN JENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KNIK GOOSE BAY RD
WASILLA AK
99654-8083
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-7800
  • Fax:
Mailing address:
  • Phone: 907-729-8961
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number231371
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24661
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: