Provider Demographics
NPI:1659865343
Name:JENSEN, CHARLES TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:TAYLOR
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:453 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4325
Mailing Address - Country:US
Mailing Address - Phone:336-402-3615
Mailing Address - Fax:
Practice Address - Street 1:6 DOCTORS CIR STE 5
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-6358
Practice Address - Country:US
Practice Address - Phone:910-721-4370
Practice Address - Fax:910-721-4379
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant