Provider Demographics
NPI:1396712519
Name:JENSEN-STANLEY, PAMELA M (DPM)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:JENSEN-STANLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 TRADEPARK DR
Mailing Address - Street 2:SOMERSET
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3428
Mailing Address - Country:US
Mailing Address - Phone:606-679-2773
Mailing Address - Fax:606-679-4626
Practice Address - Street 1:117 TRADEPARK DR
Practice Address - Street 2:SOMERSET
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3428
Practice Address - Country:US
Practice Address - Phone:606-679-2773
Practice Address - Fax:606-679-4626
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00289213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000375Medicaid
KY0714204Medicare ID - Type Unspecified
KY80000375Medicaid
4538530001Medicare NSC