Provider Demographics
NPI:1578024931
Name:BERNESTINE, JERRIA (FNP)
Entity Type:Individual
Prefix:
First Name:JERRIA
Middle Name:
Last Name:BERNESTINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3888
Mailing Address - Country:US
Mailing Address - Phone:310-756-4829
Mailing Address - Fax:
Practice Address - Street 1:8928 WAYNE ST
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-3888
Practice Address - Country:US
Practice Address - Phone:310-756-4829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A