Healthcare Provider Details

I. General information

NPI: 1174451603
Provider Name (Legal Business Name): KINSIE MARIE JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S ORCHARD ST STE 100
BOISE ID
83705-1916
US

IV. Provider business mailing address

921 S ORCHARD ST STE 100
BOISE ID
83705-1916
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-9797
  • Fax: 208-344-9898
Mailing address:
  • Phone: 208-344-9797
  • Fax: 208-344-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: