Provider Demographics
NPI:1972192961
Name:JERNIGAN, BETHANIE S
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:S
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 1:11815 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6860
Mailing Address - Country:US
Mailing Address - Phone:281-497-8479
Mailing Address - Fax:866-610-3035
Practice Address - Street 1:11815 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6860
Practice Address - Country:US
Practice Address - Phone:281-497-8479
Practice Address - Fax:866-610-3035
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician