Basic Information
| Provider Information | |||||||||
| NPI: | 1699249748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JERNIGAN | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3351 SOUTH PEAK DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109084673 | ||||||||
| FaxNumber: | 9109082240 | ||||||||
| Practice Location | |||||||||
| Address1: | 3351 SOUTH PEAK DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109084673 | ||||||||
| FaxNumber: | 9109082240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5011352 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.