Healthcare Provider Details

I. General information

NPI: 1922617489
Provider Name (Legal Business Name): KATHRYNN JENSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATTIE JENSEN

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 COOKS HILL RD
CENTRALIA WA
98531-9071
US

IV. Provider business mailing address

1793 13TH ST SE
SALEM OR
97302-2541
US

V. Phone/Fax

Practice location:
  • Phone: 971-915-8579
  • Fax: 425-970-4565
Mailing address:
  • Phone: 503-362-8385
  • Fax: 503-362-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61247639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: