Provider Demographics
NPI:1821728742
Name:JENSEN, KIANA RAE
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:RAE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKDALE ESTATES 1702 SOUTH DAKOTA 44
Mailing Address - Street 2:LOT #51
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:951-234-2135
Mailing Address - Fax:
Practice Address - Street 1:321 KANSAS CITY ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3086
Practice Address - Country:US
Practice Address - Phone:951-234-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator