Healthcare Provider Details

I. General information

NPI: 1649557760
Provider Name (Legal Business Name): JENNIFER A EISEN-KEARNS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

IV. Provider business mailing address

PO BOX 15408
SAN LUIS OBISPO CA
93406-5408
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-6500
  • Fax: 805-540-6501
Mailing address:
  • Phone: 805-540-6500
  • Fax: 805-540-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN271169
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201130023
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberVN271169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: