MEDICARE: CARLEE DIANE JENSEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1114789682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEE DIANE JENSEN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY STE 310
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1794
Country	:	US
Telephone Number	:	512-654-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/21/2026

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