Healthcare Provider Details

I. General information

NPI: 1033993191
Provider Name (Legal Business Name): AMY LOU JENSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 PARK VIEW DR
TWIN FALLS ID
83301-4084
US

IV. Provider business mailing address

1880 FILLMORE ST
TWIN FALLS ID
83301-3015
US

V. Phone/Fax

Practice location:
  • Phone: 208-738-7200
  • Fax: 208-277-3488
Mailing address:
  • Phone: 208-735-8386
  • Fax: 208-735-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberTEMP79193
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6069006-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79193
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: