Provider Demographics
NPI:1902406531
Name:JERNIGHAN, JENNIFER KEY (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KEY
Last Name:JERNIGHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-9396
Mailing Address - Country:US
Mailing Address - Phone:662-813-3133
Mailing Address - Fax:
Practice Address - Street 1:139 BELLE MEADE DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9396
Practice Address - Country:US
Practice Address - Phone:662-813-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS894951163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management