Provider Demographics
NPI:1639787526
Name:JERNIGAN, TAMRA
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 WESTWOOD MAIN DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-2609
Mailing Address - Country:US
Mailing Address - Phone:409-377-1090
Mailing Address - Fax:
Practice Address - Street 1:700 UNIVERSITY DR E STE 106
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1848
Practice Address - Country:US
Practice Address - Phone:950-397-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician