Healthcare Provider Details

I. General information

NPI: 1528598166
Provider Name (Legal Business Name): KYLIE JENSEN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W BRAKER LN
AUSTIN TX
78758-3801
US

IV. Provider business mailing address

13729 HARRISGLEN DR
PFLUGERVILLE TX
78660-4367
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9300
  • Fax:
Mailing address:
  • Phone: 641-330-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP02000909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: