Individual provider Active NPI

Keila Rae Jensen, NP

  • Primary Care Nurse Practitioner
  • Sandy, UT
National Provider Identifier
1396464277
Registry record updated Oct 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
9259955-4405 Issued in UT
Practice address
1088 E Cliff Side CT
Sandy, UT 84094-7242
Phone
(801) 663-4824
NPI assigned
Aug 24, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 9259955-4405 UT Primary

Addresses

Primary practice location

1088 E Cliff Side CT
Sandy, UT 84094-7242

Mailing address

1088 E Cliff Side CT
Sandy, UT 84094-7242
Phone (801) 663-4824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231030003135 UT Practitioner - Nurse Practitioner 6305292137 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9259955-4405UTMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Scenic Way LLC CurrentSince Jan 29, 2024 Accepting new patients
Silverton Group LLC CurrentSince Oct 3, 2023 Accepting new patients

Locations

563 W 500 S
Ste 245
Bountiful, UT 84010
Phone (801) 663-6015

5097 S 900 E
Ste 100
Murray, UT 84117
Phone (801) 576-1455

4252 S Birkhill Blvd
Salt Lake City, UT 84107
Phone (385) 425-0050

8th Ave And C St
Salt Lake City, UT 84143
Phone (801) 350-4110

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697328000000",
    "number": "1396464277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 E CLIFF SIDE CT",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840947242",
            "telephone_number": "801-663-4824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 E CLIFF SIDE CT",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840947242",
            "telephone_number": "801-663-4824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "KEILA",
        "middle_name": "RAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2023-10-15",
        "certification_date": "2023-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "UT",
            "license": "9259955-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.