Provider Demographics
NPI:1013907369
Name:FUSON, JENNIFER A (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:FUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:SADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD STE 702
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1489
Mailing Address - Country:US
Mailing Address - Phone:859-264-8811
Mailing Address - Fax:859-264-8822
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:STE 702
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-264-8811
Practice Address - Fax:859-264-8822
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34331207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64343312Medicaid
KY64343312Medicaid
G85519Medicare UPIN