Healthcare Provider Details

I. General information

NPI: 1780296913
Provider Name (Legal Business Name): CHELSEA JAYNE JENSEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KIMEL PARK DR STE 155
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-6637
  • Fax:
Mailing address:
  • Phone: 336-765-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025415-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16117
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: