Provider Demographics
NPI:1336108547
Name:JERNIGAN, ONNA (MD)
Entity Type:Individual
Prefix:
First Name:ONNA
Middle Name:
Last Name:JERNIGAN
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 1:510 GENOVESE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 GENOVESE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1531
Practice Address - Country:US
Practice Address - Phone:775-851-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8261207PE0004X, 207P00000X
AZ51516207P00000X
KS04-38633207P00000X
WI64941-20207P00000X
NMMD2015-0869207P00000X
MN60064207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV201660022Medicaid
NV002016142Medicaid
NVV101425Medicare ID - Type Unspecified
NV002016142Medicaid