Healthcare Provider Details

I. General information

NPI: 1073170270
Provider Name (Legal Business Name): HANNAH JERNIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 SHOSHONE PL
MURFREESBORO TN
37128-2869
US

IV. Provider business mailing address

1207 GLAZE CT
MURFREESBORO TN
37130-4930
US

V. Phone/Fax

Practice location:
  • Phone: 615-972-0806
  • Fax:
Mailing address:
  • Phone: 615-972-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2769
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: