Provider Demographics
NPI:1609185339
Name:JENSEN, MELISSA LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LOUISE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LOUISE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1832 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3366
Mailing Address - Country:US
Mailing Address - Phone:681-207-7130
Mailing Address - Fax:681-207-7132
Practice Address - Street 1:1832 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:681-207-7130
Practice Address - Fax:681-207-7132
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV511363A00000X
WV2316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant