Provider Demographics
NPI:1356959449
Name:JERNIGAN, MICHAEL CHET (PMHNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHET
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OLD MILL DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9023
Mailing Address - Country:US
Mailing Address - Phone:919-418-1381
Mailing Address - Fax:
Practice Address - Street 1:1319 N BRIGHTLEAF BLVD STE F
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4876
Practice Address - Country:US
Practice Address - Phone:919-934-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCJERN-XTDCS363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health