Provider Demographics
NPI:1275012908
Name:JENSEN, JESSICA RAYE (PAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAYE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E DIMOND BLVD STE 12A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1947
Mailing Address - Country:US
Mailing Address - Phone:907-341-7757
Mailing Address - Fax:
Practice Address - Street 1:300 E DIMOND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1947
Practice Address - Country:US
Practice Address - Phone:907-341-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK155221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant