Individual
TRACEY LEA JERNIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6406 N SANTA FE AVE, SUITE C, OKLAHOMA CITY, OK 73116-9111
(405) 840-2391
(405) 840-2394
Mailing address
PO BOX 16337, OKLAHOMA CITY, OK 73113-2337
(405) 840-2391
(405) 840-2394
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1875
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100723600B
—
OK
Enumeration date
02/10/2006
Last updated
05/29/2014
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