Provider Demographics
NPI:1922878123
Name:JERNIGAN, ZACHARY STEPHEN (HIS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:STEPHEN
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 CAPSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7742
Mailing Address - Country:US
Mailing Address - Phone:214-868-3611
Mailing Address - Fax:
Practice Address - Street 1:6160 SHERRY LN # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6314
Practice Address - Country:US
Practice Address - Phone:214-665-8871
Practice Address - Fax:214-363-4970
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80943237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist