Provider Demographics
NPI:1235492554
Name:JENNINGS, KARSTEN G (DO)
Entity Type:Individual
Prefix:
First Name:KARSTEN
Middle Name:G
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 IMOGENE PASS PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2910
Mailing Address - Country:US
Mailing Address - Phone:218-349-3924
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7505
Practice Address - Street 2:CREDENTIALS OFFICE RM 163
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-2092
Practice Address - Fax:719-526-7732
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00644432085R0202X
NE1053208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice