Provider Demographics
NPI:1043825482
Name:MCGHEE, JERNESHA LAWAN (NURSE)
Entity Type:Individual
Prefix:
First Name:JERNESHA
Middle Name:LAWAN
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 ORYX LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8853
Mailing Address - Country:US
Mailing Address - Phone:972-946-6199
Mailing Address - Fax:
Practice Address - Street 1:2143 ORYX LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8853
Practice Address - Country:US
Practice Address - Phone:972-946-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326802164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse