Provider Demographics
NPI:1275504698
Name:JERNIGAN, STEPHANIE L (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4044
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-1941
Practice Address - Fax:913-588-1943
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500014143OtherRR MEDICARE
500014143OtherRR MEDICARE
KSP07626Medicare UPIN
1275504698Medicare ID - Type Unspecified