Provider Demographics
NPI:1144620691
Name:CHRISTENSEN, JESSICA NICOLE (PA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4745 S 3200 W
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2822
Mailing Address - Country:US
Mailing Address - Phone:801-858-3461
Mailing Address - Fax:801-955-2389
Practice Address - Street 1:461 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3302
Practice Address - Country:US
Practice Address - Phone:801-539-8617
Practice Address - Fax:801-537-7238
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
UT9643733-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical