Provider Demographics
NPI:1225778012
Name:JERNIGAN, PATRICIA ANN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-2400
Mailing Address - Country:US
Mailing Address - Phone:912-202-6344
Mailing Address - Fax:
Practice Address - Street 1:134 BROWN ST
Practice Address - Street 2:
Practice Address - City:SCREVEN
Practice Address - State:GA
Practice Address - Zip Code:31560-9134
Practice Address - Country:US
Practice Address - Phone:912-202-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030010825376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide