Kaitlyn Jensen, LAT, PTA – Athletic Trainer

Key facts

NPI: 1174881882
Entity type: Individual (NPI type 1)
Primary specialty: Athletic Trainer 2255A2300X
License: 1260-39 (WI)
Practice address: 1110 7TH Ave
Cumberland, WI 54829-9138
Phone: (715) 822-6167
Fax: (715) 822-6142
NPI assigned: May 1, 2012
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Cumberland Memorial Hospital Inc Family Medicine Physician · Cumberland, WI · NPI 1861736472

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
2856-19	WI	MD	Physical Therapy Assistant
1260-39	WI	MD	Athletic Trainer

Practice roles

Organization	Specialty	Status	New patients
Cumberland Memorial Hospital Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Assistant	225200000X	2856-19	WI
Athletic Trainer	2255A2300X	1260-39	WI	Yes

Addresses

Primary practice location

1110 7TH Ave
Cumberland, WI 54829-9138

Mailing address

1110 7TH Ave
Cumberland, WI 54829-9138
Phone (715) 822-6167

Other names

Kaitlyn Stephens Former name

Other providers in Cumberland, WI

All providers in Cumberland, WI · Athletic Trainer in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.