Provider Demographics
NPI:1548391295
Name:JERNIGAN, DUIE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DUIE
Middle Name:R
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E 71ST ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3922
Mailing Address - Country:US
Mailing Address - Phone:918-877-2657
Mailing Address - Fax:918-877-2638
Practice Address - Street 1:1831 E 71ST ST
Practice Address - Street 2:SUITE 122
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3922
Practice Address - Country:US
Practice Address - Phone:918-877-2657
Practice Address - Fax:918-877-2638
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK422103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling