Provider Demographics
NPI:1598002602
Name:JENSEN, BRYCE PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:PAUL
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 W 9000 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8869
Mailing Address - Country:US
Mailing Address - Phone:801-567-9211
Mailing Address - Fax:801-566-5667
Practice Address - Street 1:3570 W 9000 S
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8869
Practice Address - Country:US
Practice Address - Phone:801-567-9211
Practice Address - Fax:801-566-5667
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8513765-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical