Provider Demographics
NPI:1871183723
Name:JENSEN, KATELYN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N NEW JERSEY ST APT 203
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2882
Mailing Address - Country:US
Mailing Address - Phone:419-442-1994
Mailing Address - Fax:
Practice Address - Street 1:25 N NEW JERSEY ST APT 203
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2882
Practice Address - Country:US
Practice Address - Phone:419-442-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86118299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty