Provider Demographics
NPI:1033993191
Name:JENSEN, AMY LOU (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOU
Last Name:JENSEN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3015
Mailing Address - Country:US
Mailing Address - Phone:208-735-8386
Mailing Address - Fax:208-735-0434
Practice Address - Street 1:1880 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3015
Practice Address - Country:US
Practice Address - Phone:208-735-8386
Practice Address - Fax:208-735-0434
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID79193363L00000X
UT6069006-4405363LP2300X
IDTEMP79193363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty