Healthcare Provider Details

I. General information

NPI: 1023081452
Provider Name (Legal Business Name): PENNY KAYE JENSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SALT LAKE VETERANS AFFAIRS HEALHCARE 500 FOOTHILL DRIVE
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

500 FOOTHILL DRIVE SALT LAKE CITY VA HEALTHCARE SYSTEM
SALT LAKE CITY UT
84148-2415
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2503
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2170254405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: