Individual
AMANDA JERNIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
(505) 609-2259
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
APN0000019375
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA-56272
NM
Other
Enumeration date
01/02/2015
Last updated
07/17/2019
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