Active NPI
Jacqueline Jernigan
- Professional Counselor
- Grand Prairie, TX
National Provider Identifier
1043925761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 90538
- Practice address
- 4683 Betts Dr Ste 403
Grand Prairie, TX 75052-1807 - Phone
- (469) 726-9813
- NPI assigned
- Jan 17, 2023
- Last updated
- Jan 17, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 90538 | TX | Primary |
Addresses
Primary practice location
4683 Betts Dr Ste 403
Grand Prairie, TX 75052-1807
Mailing address
4041 W Wheatland Rd # 156-463
Dallas, TX 75237-4063
Phone (469) 726-9813
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92-1779554 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90538 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673913600000",
"number": "1043925761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4041 W WHEATLAND RD # 156-463",
"city": "DALLAS",
"state": "TX",
"postal_code": "752374063",
"telephone_number": "469-726-9813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4683 BETTS DR STE 403",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750521807",
"telephone_number": "469-726-9813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERNIGAN",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-17",
"last_updated": "2023-01-17",
"certification_date": "2023-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "90538",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92-1779554",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.