Provider Demographics
NPI:1689055881
Name:JERNIGAN, WAYNE EDWARD SR (APRN)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:EDWARD
Last Name:JERNIGAN
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6843
Mailing Address - Country:US
Mailing Address - Phone:931-841-1153
Mailing Address - Fax:
Practice Address - Street 1:3990 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6843
Practice Address - Country:US
Practice Address - Phone:931-841-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19949363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care