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 1:153 W 151ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-764-1125
Mailing Address - Fax:913-764-1186
Practice Address - Street 1:153 W 151ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-764-1125
Practice Address - Fax:913-764-1186
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41054207N00000X, 207N00000X
KS04-48973207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000623056OtherANTHEM
KY1182306Medicare PIN
TN3066425Medicare PIN
000000623056OtherANTHEM