Provider Demographics
NPI:1649021478
Name:JENSEN, MACKENZIE ANN (DO)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 RAY HILL RD APT A
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-8712
Mailing Address - Country:US
Mailing Address - Phone:260-466-5477
Mailing Address - Fax:
Practice Address - Street 1:800 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2347
Practice Address - Country:US
Practice Address - Phone:270-745-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program