Provider Demographics
NPI:1598986184
Name:JERNIGAN, PAMELA Y (APRN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:Y
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 VERMONT AVE.
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-482-4078
Mailing Address - Fax:865-482-4960
Practice Address - Street 1:80 VERMONT AVE.
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-482-4078
Practice Address - Fax:865-482-4960
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN 67928364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028123Medicaid