Provider Demographics
NPI:1962076331
Name:JERNIGHAN, STEPHANIE D
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:JERNIGHAN
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 1:2155 PALM BAY RD NE STE 7
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2907
Mailing Address - Country:US
Mailing Address - Phone:321-220-0862
Mailing Address - Fax:
Practice Address - Street 1:2155 PALM BAY RD NE STE 7
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2907
Practice Address - Country:US
Practice Address - Phone:321-220-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171400000XOther Service ProvidersHealth & Wellness Coach
No252Y00000XAgenciesEarly Intervention Provider Agency