Tracey Lea Jernigan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1875 Issued in OK

Practice address

6406 N Santa Fe Ave
Suite C
Oklahoma City, OK 73116-9111

Phone

(405) 840-2391

Fax

(405) 840-2394

NPI assigned

Feb 10, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tracey Lea Prichard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1831162502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16337",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731132337",
            "telephone_number": "405-840-2391",
            "fax_number": "405-840-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6406 N SANTA FE AVE",
            "address_2": "SUITE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731169111",
            "telephone_number": "405-840-2391",
            "fax_number": "405-840-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "TRACEY",
        "middle_name": "LEA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "1875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100723600B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "PRICHARD",
            "middle_name": "LEA",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeri Ellis MD MPH PC
• Lauren Jerichow, APRN-CNP
• Carla Louise Jernigan, RSS, WELLNESS COACH
• Claudia Jernigan
• Julia Nicole Jernigan, BHRS/PRS
• Jerry L. Mullen, O.D., P.C.
• Jerry R. Teel, PHD PC
• Leah Marie Jeryc
• Christina Ann Jester
• Jamie Claire Jester

• Clinical Social Worker in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.