Healthcare Provider Details

I. General information

NPI: 1285551259
Provider Name (Legal Business Name): RACHEL JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 TYHEE AVE
AMERICAN FALLS ID
83211-1224
US

IV. Provider business mailing address

645 W CENTER ST
POCATELLO ID
83204-3237
US

V. Phone/Fax

Practice location:
  • Phone: 208-226-1057
  • Fax:
Mailing address:
  • Phone: 208-539-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: