Provider Demographics
NPI:1427714013
Name:JERNIGAN, SARAH E (RD, LD, IBCLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:RD, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1408
Mailing Address - Country:US
Mailing Address - Phone:469-525-6717
Mailing Address - Fax:
Practice Address - Street 1:3022 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1408
Practice Address - Country:US
Practice Address - Phone:469-525-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85834133V00000X
KY252645133V00000X
OHLD.10316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered