Provider Demographics
NPI:1578855797
Name:JERNIGAN, CARLA LOUISE (RSS, WELLNESS COACH)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LOUISE
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:RSS, WELLNESS COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5104
Mailing Address - Country:US
Mailing Address - Phone:405-425-0356
Mailing Address - Fax:405-425-0441
Practice Address - Street 1:4400 N LINCOLN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5104
Practice Address - Country:US
Practice Address - Phone:405-425-0356
Practice Address - Fax:405-425-0441
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor