Provider Demographics
NPI:1114967023
Name:MARTIN, JENNIFER DEMPSEY (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEMPSEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2301 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4908
Mailing Address - Country:US
Mailing Address - Phone:615-327-9797
Mailing Address - Fax:615-613-0329
Practice Address - Street 1:2301 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4908
Practice Address - Country:US
Practice Address - Phone:615-327-9797
Practice Address - Fax:615-613-0329
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41054207N00000X, 207N00000X
KYTP506207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000623056OtherANTHEM
KY1182306Medicare PIN
TN3066425Medicare PIN
000000623056OtherANTHEM