Provider Demographics
NPI:1811869340
Name:JENSEN, ALYSSA LYNN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:CANADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1301
Mailing Address - Country:US
Mailing Address - Phone:620-762-0000
Mailing Address - Fax:
Practice Address - Street 1:403 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOLDEN CITY
Practice Address - State:MO
Practice Address - Zip Code:64748
Practice Address - Country:US
Practice Address - Phone:417-537-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025028308363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care