Provider Demographics
NPI:1356676340
Name:EAVES, JENNIFER GUNTER (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GUNTER
Last Name:EAVES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 SISKIN PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1306
Mailing Address - Country:US
Mailing Address - Phone:423-803-2226
Mailing Address - Fax:423-803-2222
Practice Address - Street 1:1 SISKIN PLZ STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1306
Practice Address - Country:US
Practice Address - Phone:423-803-2226
Practice Address - Fax:423-803-2222
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA1757363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4253479OtherBCBS - TENNESSEE
TN1526386Medicaid
TN1526386Medicaid