Provider Demographics
NPI:1992930846
Name:SAUCEMAN, JENNIFER LEA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEA
Last Name:SAUCEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 CROWE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7264
Mailing Address - Country:US
Mailing Address - Phone:423-623-0653
Mailing Address - Fax:
Practice Address - Street 1:1829 CROWE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7264
Practice Address - Country:US
Practice Address - Phone:423-623-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00689208000000X
TNMD51151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921176Medicaid
TNQ005159Medicaid
TNQ005159Medicaid