Basic Information
| Provider Information | |||||||||
| NPI: | 1598986184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JERNIGAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 VERMONT AVE. | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 VERMONT AVE. | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | RN 67928 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | Q028123 | 05 | TN | MEDICAID |