Provider Demographics
NPI:1235491390
Name:CHRISTENSEN, JESSICA ANNE (MCMSC, PA-C, ATC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MCMSC, PA-C, ATC
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:RADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCMSC, PA-C, ATC
Mailing Address - Street 1:200 COMMONS WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1915
Mailing Address - Country:US
Mailing Address - Phone:406-752-5170
Mailing Address - Fax:
Practice Address - Street 1:200 COMMONS WAY STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT112ATR2255A2300X
MTMED-PAC-LIC-44827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer