Provider Demographics
NPI:1568977460
Name:JERNIGAN, SHEREE KEMP (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:KEMP
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WISDOM DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-5937
Mailing Address - Country:US
Mailing Address - Phone:281-507-7373
Mailing Address - Fax:281-507-7373
Practice Address - Street 1:902 WISDOM DR
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-5937
Practice Address - Country:US
Practice Address - Phone:281-507-7373
Practice Address - Fax:281-507-7373
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759196163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant