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General NPI Number Information
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NPI Number | 1497955330
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Entity Type | Individual
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Provider Name | KELLY D JENSEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 280 N HOSPITAL DR
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City | PRICE
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State | UT
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Zip | 84501-4216
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Country | US
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Telephone | 435-637-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 280 N HOSPITAL DR STE 3
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City | PRICE
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State | UT
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Zip | 84501-4211
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Country | US
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Telephone | 435-623-7260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OT012058
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License Number State | PA
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