Healthcare Provider Details

I. General information

NPI: 1164552949
Provider Name (Legal Business Name): LINDA KAY JENSEN ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ASH LN
LANSING KS
66043-6286
US

IV. Provider business mailing address

451 ASH LN
LANSING KS
66043-6286
US

V. Phone/Fax

Practice location:
  • Phone: 573-855-9783
  • Fax:
Mailing address:
  • Phone: 573-855-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number102080
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: