Healthcare Provider Details

I. General information

NPI: 1376797472
Provider Name (Legal Business Name): NICHOLAS ALLEN JERNIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SOUTHEND CT BLDG 9
HAMPSTEAD NC
28443-7013
US

IV. Provider business mailing address

20 SOUTHEND CT
HAMPSTEAD NC
28443-7013
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-3673
  • Fax:
Mailing address:
  • Phone: 910-270-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010-00748
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2010-00748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: