Provider Demographics
NPI:1912771437
Name:JERNIGAN, KRYSTAL K
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:K
Last Name:JERNIGAN
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 1:1802 NEWPORT CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-6330
Mailing Address - Country:US
Mailing Address - Phone:847-219-2569
Mailing Address - Fax:888-865-2452
Practice Address - Street 1:1802 NEWPORT CT
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-6330
Practice Address - Country:US
Practice Address - Phone:847-219-2569
Practice Address - Fax:888-865-2452
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)