Jernigan, Tracey Lea

Jernigan, Tracey Lea is an sole proprietor health care provider with primary practice located at 6406 N Santa Fe Ave Suite C, Oklahoma City OK 73116-9111. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jernigan, Tracey Lea can be contacted via phone (405) 840-2391.

Contact Information

Primary practice address
6406 N Santa Fe Ave Suite C Oklahoma City OK 73116-9111
Phone: (405) 840-2391
Fax: (405) 840-2394
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1875 Oklahoma

Profile Details

NPI number 1831162502
LBN Legal business name Jernigan, Tracey Lea
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 10th, 2006
Last updated May 29th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831162502 NPPES
Oklahoma MEDICAID 100723600B

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