Provider Demographics
NPI:1699249748
Name:JERNIGAN, STEVEN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 SOUTH PEAK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-908-4673
Mailing Address - Fax:910-908-2240
Practice Address - Street 1:3351 SOUTH PEAK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-908-4673
Practice Address - Fax:910-908-2240
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner