Provider Demographics
NPI:1518443142
Name:JENSEN, RACHEL ANN (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:ROTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:DESTINATION HEALTH 900 E. SOUTHLAKE BLVD. #200
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-310-6050
Mailing Address - Fax:
Practice Address - Street 1:900 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6376
Practice Address - Country:US
Practice Address - Phone:817-310-6050
Practice Address - Fax:817-310-6051
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine