Provider Demographics
NPI:1528670254
Name:JERNAGIN, MYEYA
Entity type:Individual
Prefix:
First Name:MYEYA
Middle Name:
Last Name:JERNAGIN
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 1:53 1/2 W HURON ST STE 221
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2121
Mailing Address - Country:US
Mailing Address - Phone:248-495-2700
Mailing Address - Fax:
Practice Address - Street 1:53 1/2 W HURON ST STE 221
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2121
Practice Address - Country:US
Practice Address - Phone:248-495-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide