Provider Demographics
NPI:1659119881
Name:JERNIGAN, MELINDA M (FNP-C)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16203 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-9320
Mailing Address - Country:US
Mailing Address - Phone:346-251-4501
Mailing Address - Fax:346-253-1367
Practice Address - Street 1:16203 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-9320
Practice Address - Country:US
Practice Address - Phone:346-251-4501
Practice Address - Fax:346-253-1367
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187816363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty