Healthcare Provider Details

I. General information

NPI: 1508165739
Provider Name (Legal Business Name): AMY N JENSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY N HANSEN FNP-C

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NW STATE ROUTE 7 STE B
BLUE SPRINGS MO
64014-2749
US

IV. Provider business mailing address

730 SW GINGER HILL DR
GRAIN VALLEY MO
64029-8417
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-8880
  • Fax: 816-229-4363
Mailing address:
  • Phone: 816-520-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011007236
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003009690
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011007236
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: